The Chancellor continues to be of the opinion102 that the protection of the health and human dignity of the patients must be ensured in all situations during the provision of nursing care services. The existence of a nurse call system contributes to the achievement of these objectives. Its absence significantly restricts a patient’s possibility to swiftly notify of the deterioration of their condition or the need for care. Also, the system can only be useful if it works, is easily accessible for the patients and the patients have been informed of its existence and possibility of use. For these reasons, the Chancellor proposed to ensure the existence of a nurse call system and better inform the patients (repeatedly, if necessary) of its existence and possibilities of use. 8.3. Consent for the provision of nursing care services During the reporting year, the Chancellor paid more attention to the existence of a consent for the provision of nursing care services. Problems with documenting the consent were found in four103 of the inspected institutions. For example, there were cases where no consent for the provision of nursing care services had been obtained104 or it had been obtained from a person who did not necessarily understand the meaning of the consent.105 As the treatment documents of several patients lacked a written record of the consent for the provision of the services and no explanations with regard to the person’s incapacity to decide had been given, the Chancellor had a suspicion whether a legally required consent had been obtained from all the recipients of nursing care services or their legal representatives.106 PART II The inspection visits carried out during the reporting year revealed insufficiencies in the nurse call system in two institutions.99 In one of them100 refurbished wards had a nurse call system but it was switched off, while in the rest of the wards the system did not exist at all. In another institution101 one of the houses had a nurse call system but some of the patients were not aware of it, while in another house of the same institution the system did not exist at all. PART III 8.2. Nurse call system PART IV the Chancellor proposed to the service providers to explain to their staff that tying up of nursing care patients (except in case of need for the duration of a medical procedure) is not allowed. Even if consent for this was given by a patient’s next of kin or their guardian. In addition, the Chancellor asked to consider training of the staff on the issues of the prevention of the need to tie up patients and implementing alternative measures to tying up. PART I CHANCELLOR OF JUSTICE AS NATIONAL PREVENTIVE MECHANISM Consenting to the provision of a health service concerns the freedom to decide over a person’s physical and mental inviolability protected under §  26 and §  19 of the Constitution. As the 99 See the inspection visits to Sillamäe Hospital Foundation (case No 7-9/130437) and Kallavere Hospital Ltd (case No 7-9/131434). 100 See the inspection visit to Sillamäe Hospital Foundation (case No 7-9/130437). 101 See the inspection visit to Kallavere Hospital Ltd (case No 7-9/131434). 102 See the 2012 inspection visits to Jõgeva Hospital Foundation (case No 7-9/130302) and Rapla County Hospital Foundation (case No 7-9/13027). 103 See the inspection visits to PJV Nursing Care Foundation (case No 7-9/140101), East Tallinn Central Hospital Ltd (case No 7-9/131500), Kilingi-Nõmme Health and Care Centre Foundation (case No 7-9/131307) and Kallavere Hospital Ltd (case No 7-9/131434). 104 See the inspection visits to East Tallinn Central Hospital Ltd (case No 7-9/131500), PJV Nursing Care Foundation (case No 7-9/140101), Kilingi-Nõmme Health and Care Centre Foundation (case No 7-9/131307) and Kallavere Hospital Ltd (case No 7-9/131434). 105 See the inspection visit to Kallavere Hospital Ltd (case No 7-9/131434). 106 In case of absence of a legal representative, the patient’s next of kin, the patient himself or herself or the local authority should submit an application to the court for the restriction of the patient’s capacity. If a legal representative has been appointed the health service provider must examine the relevant court decision and on the basis of it determine with regard to which issues and to what extent the patient’s appointed guardian may decide instead of the patient. 37