Hospitals and psychiatric institutions 2.2 Hospitals and psychiatric institutions 2.2.1 Introduction In the year under review, the commissions of the NPM visited 36 medical facilities including 21 psychiatric and 15 somatic clinics or wards. Most of the observations made by the commissions in the year under review dealt with the issues of “health care” (18) and “measures that restrict freedom” (17). There were also critical observations on personnel matters (13) and structural deficits (12). With regard to current formal legal suggestions made by the NPM in the area of preventive human rights monitoring, the (former) Federal Ministry of Health and Women’s Affairs promised improvements in the Hospital and Convalescent Homes Act (Krankenanstalten- und Kurzanstaltengesetz) and the Hospitalisation of Mentally Ill Persons Act (Unterbringungsgesetz) in a declaration in July 2017. The “Health” area was transferred to the field of competence of the Federal Ministry of Labour, Social Affairs, Health and Consumer Protection in January 2018 as a result of the amendment to the Federal Ministry of Health in 2017. The NPM tentatively assumes that preventive human rights monitoring in health care institutions and facilities will continue to be developed by the new Federal Minister using the results achieved to date as a base. Central recording of measures that restrict freedom In accordance with the long-standing demand by the NPM, the Ministry promised that the obligation for psychiatric wards and hospitals to keep a central register for recording measures that restrict freedom will be enshrined in law with the next amendment of the Hospital and Convalescent Homes Act. A legal amendment is necessary because the commissions again observed in the year under review 2017 that central registers in medical facilities were not in place on a nationwide basis. An anonymous central register that complies with the CPT standards is a vital condition for an effective and systematic prevention strategy to reduce the use of measures that restrict freedom. The central register makes it possible to compare the number of such measures inside the clinic but also between the medical facilities. Only when these data are available can there be a concrete discussion on how such measures can be avoided. They also form the basis for developing pertinent strategies that help the institutions to avoid measures that restrict freedom. Sexual harassment by hospital personnel The Human Rights Advisory Council has dealt with the problem of sexual harassment of patients by personnel in depth and developed recommendations for improvement for the purpose of a preventive approach (see NPM Report 2016, p. 49 et seq.). One suggestion was that the patient advocacies of the Laender should be invited when there are allegations of sexualised violence to patients.They could assist the victim support groups in hospitals, especially if a member of the medical facility staff is suspected. According to one promise, 42