7. Outstanding issues in effective prevention of ill-treatment copies even without the patient’s consent. The problem is that documentation of nursing care constitutes a part of medical records and the relevant laws do not provide for the inspectors’ access to it. The Ministry of Labour and Social Affairs has not been able so far to secure the necessary legislative changes with the Ministry of Health, which is responsible for this area. It is necessary to amend the Healthcare Services Act and include social services inspectors among entities authorised to peruse medical records even without the patient’s consent. Unsatisfactory standard in psychiatric hospitals psychiatric facilities Issue: Patients who cannot independently leave the unit due to their medical condition have not access to outdoor exercise on a daily basis. A number of facilities provide accommodation in dormitories housing many patients. The pending reform of psychiatric care aims to develop community services – many patients would thus no longer receive care in large institutional facilities. However, large psychiatric hospitals will remain the main care providers for several years. A strategic approach is also lacking in terms of decreasing the need for using means of restraint psychiatric facilities Issue: The legal regulation of criteria for the use of means of restraint is not in conformity with the European standard. However, full compliance with the standard, including the principles of necessity and subsidiarity, is hindered by a number of persisting issues. In practice, there is a lack of specific conditions for alternative resolution of dangerous patient behaviour. At certain workplaces, means of restraint are used preventively and in the long term because of inadequate material equipment and insufficient staff, without this leading to any adjustment in the manner of providing care. Not only patients, but also the attending personnel are in a danger of injury and trauma. The health staff often do not distinguish between treatment and pharmacological restraints. State oversight is ineffective. Because records of the use of means of restraint in the current form, as laid down by the Healthcare Services Act (Section 39 (4)), only provide an irrelevant statistic, effective monitoring and inspection of restraints remains difficult. Potential solution: The use of means of restraint will not decrease without conceptual development of their prevention and alternative means, and without a clear signal from the Government that it will no longer tolerate care relying on the use of restraints. Constant guidance and supervision is also necessary. The attitude to the use of net beds has not changed healthcare services facilities Issue: Although the CPT has regularly recommended to the Government of the Czech Republic to discontinue the use of this means of restraint since 2002, net beds remain in use. It is unknown how many such beds are used in Czech healthcare facilities. It is likely that the number is much lower than 120 established by the survey of 2012. However, the Government has not yet adopted the necessary steps to implement its 2015 promise to the CPT that it would seek ways to discontinue the use of net beds. Since then, in view of the risks involved, it has been prohibited to use net beds in sobering-up stations, but they remain a legal means of restraint in other healthcare services. The Ministry of Health remains inactive and some physicians are concerned that net beds will simply be replaced by other means of restraint. Potential solution: Adopt a strategic approach that would include search for and promotion of effective alternatives to the use, not only of net beds, but of means of restraint in general. 23