Insulin: supporting safe administration in inpatient settings

NHS England welcomes this report and the series of which it is a part and is developing a detailed response in line with the recommendations, in discussion with other healthcare partners. NHSE will align this with its outputs from the related, forthcoming reports around the administration of insulin, and will update HSSIB with further information on their plans as they develop, setting out its full, formal response once all reports in the series have been released. Response received on 13 July 2026.

The RCP is committed to patient safety and the use of NEWS2 as a method of recording observations so deterioration can be recognised. Following the publication of the HSSIB report, the RCP is undertaking an investigation exercise to identify key data which uses the correct NEWS2 observations including glucose. Data will be then considered with key stakeholders including Diabetes UK and the Joint British Diabetes Societies for Inpatient Care. Consideration will be taken around inclusion of both high and low glucose levels and whether the score needs to be adjusted for those patients living with diabetes. The RCP is mindful that NEWS2 has been successful to date due to its reproducibility across a wide variety of patients but settings and any changes should be evidenced based. Actions planned to deliver safety recommendation: Collection of data relating to NEWS 2 and Glucose, by September 2026. Resources in place to deliver actions: DCAP - Diabetes Care Accreditation Unit and Fellows of the RCP with an interest in diabetes. Additional comments: Discussions ongoing with other organisations about diabetes care in the acute patient setting. Meeting to discuss inclusion of glucose in NEWS – Review of the evidence, by November 2026. Resources in place to deliver actions: DCAP - Diabetes Care Accreditation Unit, RCP Standards Directorate / Acute Deterioration Board. Publication of decision re inclusion of glucose in NEWS 2, by March 2027. Resources in place to deliver actions: Acute Deterioration Board. Additional comments: Any decision / statement will need to be taken to Council after consideration in both Acute Deterioration Board and the Medical Specialties Board Work is starting on an Acute Deterioration Toolkit which will include a section on glucose monitoring and other observation parameters which have also been raised as needing to be incorporated into NEWS 2. Response received on 22 June 2026.

We welcome the recommendation to consider and assess how we can use data from both the Diabetes Care Accreditation Programme and the new National Diabetes Audit for Inpatient Care to inform our regulatory activity of NHS acute trusts. National Diabetes Audit We have an established process to access, assess suitability, and utilise National Audit datasets as routine part of our regulatory approach. We will seek access to the National Diabetes Audit dataset as part of this process, to enable us to assess its potential application. Diabetes Care Accreditation Programme (DCAP) We continue to support the use of clinical accreditation as valued evidence for our assessments. We were engaged at the introduction of Diabetes Accreditation Programme (DCAP), and we are working with DCAP to review its potential application and its information on challenges in diabetes care for regulation. Previously, we have assessed accreditation schemes against criteria to be approved as a CQC information source. This included there being adequate uptake to enable benchmarking, involvement of patients, and alignment with our assessment framework. CQC is undergoing a rebuilding programme, including our regulatory model and our assessment framework. The draft hospital framework, although under development, includes under Delivering evidence-based care and treatment , scope to consider participation in accreditation schemes. When we have done further work to confirm and agree our assessment framework we will review of our use of accreditation schemes within our inspections. We will need to consider the re-establishment of internal governance processes to assess and assure accreditation schemes. Actions planned to deliver safety recommendation: National Diabetes Audit Engagement with NHSE for access to NDISA data - completed. Additional comments: Meeting held on 1 June 2026 - Agreement to explore range of audits and measures for use in CQC’s monitoring and assessment processes. Scoping of outputs from NDISA to establish usability for regulatory purposes, next meeting by September 2026. Resources in place to deliver actions: Representatives from CQC’s data and insight teams, and input from Hospitals leads. Other dependencies identified: Engagement with NHSE leads to explore available indicators and timeliness. Data processing and implementation in relevant dashboard for regulatory use - subject to scoping progress. Other dependencies identified: Access to datasets for CQC to incorporate into its systems. Diabetes Care Accreditation Programme Continued engagement with DCAP to: - Share our current position on the use of accreditation schemes, our previous assessment criteria and the potential for DCAP to seek UKAS assurance as an alternative. - Understand about DCAP and how it can inform our regulatory activity, existing and projected uptake of the scheme, by April 2027. Resources in place to deliver actions: Representatives from acute policy team, data & insight and operations. Additional comments: First meeting held 29/04/2026. Consider the re-establishment of internal governance processes to assess and assure accreditation schemes, including DCAP, as a CQC information source for our regulation, by: TBC. Resources in place to deliver actions: This will need to be delivered within the wider regulatory approach development work, within existing resources, and as a cross-cutting issue that impacts the four inspectorates. Other dependencies identified: CQC rebuilding work which significantly impacts available resources. Additional comments: The priority of this action needs to be assessed before a deadline and nominated lead can be given and resources identified. Response received on 22 June 2026.