_ From the evidence it was apparent that nurse training on wards M4 and A11 was deficient and their understanding of the importance and danger of Type Diabetes seemed to be limited at best: The nurses were unable to say why they had not escalated her care on a number of occasions. ALL the doctors in training need to be aware that they should not omit any dose of 'long-acting insulin' The consultant expressed the 'hope' that they would know this; but the evidence suggested the contrary: It was evident that the nursing staff on, for example; the surgical wards, did not have any specialist outreach nurse advice on such things as diabetes_ May 17th

There was an obvious need for additional consultant cover for Diabetes. was told that funding has been put in place to cover this, but as no one has been appointed to fulfil this vital role_ The specialist outreach Nurse Practitioner for diabetes was booked off sick for one month; and no 'cover' was in place to cover his absence There was either a lack of equipment or a lack of understanding by the staff as to what equipment was needed by them: The staff indicated that were unable to find 'ketone dipsticks' , for diabetic urine sampling: was told that in fact these are unnecessary in that ketone blood tests are now routine. Similarly was told they could not find any or sufficient cardiac monitors on the ward: Further evidence revealed there are in excess of 240 such monitors in the hospital but the relevant staff seemed unaware of this. were also unaware that could have used the ward based defibrillator for the same purpose: There was a considerable of approximately 12 hours in moving her to ward A3 after this had been deemed the appropriate place for her to be: No reason for this delay was offered: It was conceded by the 'Head of Risk' for the Trust; that there was a general under resourcing within the Trust for the care of patients with Diabetes