the Midi-Pyrénées and Ile-de-France Regions. She had drawn attention to two points: firstly, that health professionals were doing their utmost to respect patient-physician and treatment confidentiality under all circumstances and, secondly, that the certification process bearing on health facilities, implemented at periodic intervals, took this subject on board. Lastly, the Minister had recalled the principle of appointing an identified practitioner for monitoring patients placed in secure rooms, the specific internal training measures given to nursing staff working in secure rooms and the need for close cooperation between the prison administration and the public hospital services as regards the living conditions in secure rooms. A few months after the opinion was published, the Prison Administration Director issued her departments with an instruction15 reiterating that there should not be any exception to the rule set out in Art.52 of the Prison Act of 24 November 2009 as follows: "any delivery or gynaecological examination must be performed without restraints and without the presence of the prison staff, in order to guarantee the right to respect of the dignity of detained women". This note presents the security measures in detail that it is possible to take based on the different situations likely to be encountered during the external movements of female prisoners who are more than six months pregnant. The assessment report for the 2010-2014 strategic action plan bearing on the health policy for prisoners, drawn up by the General Inspectorate of Social Affairs and General Inspectorate of Legal Services, was submitted to the Government in November 2015 and published during the first half of 2016. This document makes the overall observation that prisoners have significant health needs, and yet their state of health is poorly documented. It points out that while the 1994 reform had laid the foundations for the necessary cross-government cooperation, beyond the cooperation that exists on a day-to-day basis on the ground this remains complex. It has particularly undermined the management and coordination of the 2010-2014 plan. The mission finds that the provision of health care is highly disparate and still inadequate overall. It pinpoints several policy areas that need to be taken further – particularly in terms of prevention, addictions and suicide prevention. It recommends new courses for action regarding the affiliation of prisoners to social protection, simplifying the financing of health care services in favour of prisoners and improving access to care outside detention; in the mission's vi ew, this latter point is to be achieved by more effectively organising external movements of prisoners and by developing sentence adjustments for medical reasons. Finally, the mission recommends new guidelines: health care in relation with the offence for which the person has been convicted, treatment for the loss of independence associated with ageing and disability, and the question of prisoners nearing the end of their lives. Regarding the questions addressed in the CGLPL's 2015 opinion, the mission also observed a high rate (around 20%) of external movements for medical reasons that are planned but not carried out, and a widespread, excessive use of restraint methods that is hardly respectful of personal dignity or medical confidentiality. It advocates amending standard protocol to be able to allow release authorisations for several days in order to receive care – when the criminal profile of the prisoner permits this – as well as the use of conventional sentence adjustments to enable care to be received. During its visits to institutions and its investigations, the CGLPL has not observed any improvements in the situation it described in 2015, despite the similar observations made by the General Inspectorate of Social Affairs and General Inspectorate of Legal Services, the fact that the Government does not contest these findings and the reminder of the applicable rules. There have 15 Note dated 8 December 2015, on the restraint means and surveillance measures during the external movements of prisoners on the grounds of their pregnancy or for a gynaecological examination. 66