8. Long‑standing issues in effective prevention of ill-treatment A strategic approach is also lacking to decreasing the need for using means of restraint. The legal regulation of criteria for the use of means of restraint is currently in conformity with the European standard. Full compliance with the standard, including the principles of necessity and subsidiarity, is prevented by a number of issues persisting in practice. ―― Special register of the use of means of restraint in the current form, as laid down by the Health Care Services Act, is an irrelevant statistic. It is therefore difficult to monitor their use. ―― The doctors often do not distinguish between treatment and so called chemical restraint. Methodology and constant awareness raising are missing. ―― At certain workplaces, means of restraint are used preventively and in the long term because of inadequate material background and staff, without this leading to any change in the manner of providing care. Not only patients, but also the attending personnel are in a danger of injury and trauma. Constant methodical and supervision work is lacking. Remedy of shortcomings found by the State inspection and investigation of complaints is unenforceable State inspection in the field of health care services could help prevent ill-treatment, but its effectiveness is decreased by insufficient definition of powers in the law. Inspection bodies may impose measures to remedy the shortcomings found, set deadlines for adopting the measures and request reports on progress. However, if the provider remains inactive or adopts insufficient measures, the inspection body has no means of enforcing the remedy. The same is true of the results of proceedings on complaints. This reduces the effect of inspection activities as well as the providers’ respect. It is necessary to add into the Health Care Services Act the authority to impose a fine on a provider who fails to adopt a remedial measure. 29