Barnet and Chase Farm Hospitals [NHS] NHS Trust Barnet Hospital Wellhouse Lane Barnet Hertfordshire ENS 3DJ wwwbcf nhs.uk Mr Andrew Walker Tel: 0845 111 4000 Senior Coroner North London Coroners Court 29 Wood Street Barnet ENS 4BE 7 April 2014 Sir Grace Bates, Deceased Regulation 28 Report to prevent future deaths am responding to your concerns that there should be a specialist diabetic nurse available over the weekend at the hospital. Our Head of Diabetes & Endocrinology; Business Manager for Diabetes and our Lead Diabetes Nurse submitted a business case for the approval for the appointment of a minimum of one WTE IPDSN to complement the current diabetes team, to provide improved cover for the Hospital across the calendar week The business case has been approved and an appointment is awaited_

From the Rt Hon Jeremy Hunt MP Secretary of State for Health Department of Health Richmond House 79 Whitehall London POC1834309 SWIA 2NS Tel: 020 7210 3000 Mr Andrew Walker Mb-sofs@dh-gsi-gov.uk HM Senior Coroner Northern District of Greater London North London Coroners Court 29 Wood Street Barnet 1 FCO 204! ENS 4BE J L Thank you for letter about the inquest into the death of Grace Mary Bates. On 21 April 2013, Mrs Bates died as the result of complications from poorly managed diabetic episodes following admission to Barnet Hospital. The medical cause of death was complications of diabetes mellitus. Your report summarised the circumstances regarding Mrs Bates' death, noting in particular; the poor management of blood sugar levels and the absence of a specialist diabetic nurse over the weekend. All registered nurses (RNs) are accountable for and have skills in blood glucose monitoring: Their skills include monitoring blood glucose, recording findings, evaluating whether each reading falls within an expected range and taking the necessary action_ This is the most elementary level of care_ In more specialist areas, as endocrinology wards, which may have a higher concentration of people with diabetes, it is usual for RNs to have developed their competence in titrating medicines in response to blood glucose readings. In this silualiol, le Trust should apply clinical governance mechanisms to enable this to take place safely and effectively. The National Institute for Health and Care Excellence (NICE) quality standard on diabetes states that people with diabetes admitted to hospital should be cared for by appropriately trained staff and be provided with access to a specialist diabetes team. These standards provide an authoritative definition of good quality care and should be used as a basis for best practice. well~ , your such

Local organisations are best placed to assess the needs oftheir populations, and to commission and deliver high-quality, safe and comprehensive diabetes services; including appropriate nursing staff and I expect local healthcare organisations to do their utmost to deliver care against NICE standards as part of a general duty to ensure continuous improvement in quality. The wider issue of patient outcomes and weekend admissions has been recognised as a matter of national significance. NHS England has assessed the considerable evidence which has emerged over the last ten years, linking the reduced level of service provision at the weekend to poor outcomes for patients admitted to hospital as an emergency. The NHS Services Seven Days a Week Forum, established by the National Medical Director Sir Bruce Keogh, has developed ten clinical standards describing the standard of urgent and emergency care that all patients should expect to receive on every of the week. Their delivery should reduce the risk of morbidity and mortality following weekend admission in a range of specialties including diabetes, and provide consistent NHS services, across all seven of the week: The Forum has not attempted to specify the roles and of staff that should be present at weekends, except in the case of medical consultants where there is good evidence about the effect of absence of senior decision makers. The standards describe how quickly admitted patients should be seen and assessed on every day of the week by a suitable medical consultant; defined as one who is familiar with the type of emergency presentations in the relevant specialty and is able to initiate a diagnostic and treatment plan' . The clinical standards are attached for your convenience and further information about the work of the forum can be found at http:ILwww england nhs uklourwork/qual-clin-lead/Z-day-weekl NHS England's ambition is for all the clinical standards to be adopted in every community in England by the end of 2016/17. With a number of our strategic partners, we will use a range of incentives, rewards and sanctions, including the NHS Standard Contract, to support the change. I do that this information is helpful and I thank you for bringiug lhis ipllanl issue to my attention. W sm~s RECEIVED JEREMY HUNT 13 FEB 2014 day days grades key hopc