Source · HSSIB Patient Safety Investigation
Insulin: supporting safe self-administration for patients in the community with a disability
HSSIB’s introductionDiabetes is one of the most common chronic diseases in England and the number of people with the condition is on the increase. It is a condition where blood glucose levels are too high due to various factors, including problems with the pancreas (which produces insulin). People with diabetes require their blood glucose levels to be monitored and to be maintained within a specified range. Where blood glucose levels are not maintained adequately, short-term and long-term problems can arise for the person which can be life-threatening.
Published 19 May 2026
Published
Mental health
Medication
Learning disabilities
Indexed content
2 recommendations
1 observation
13 learning prompts
2 of 2 responded
Safety Recommendations
HSSIB recommends that NHS England/Department of Health and Social Care provides guidance to integrated care boards and community providers setting out expectations for service models that empower and support people to manage and administer insulin in community settings. This is to support recognition of models that have safely, effectively and equitably engaged patients, their families and carers, including through the use of modern diabetes technology for self-management.
AI-generated response summary NHS England will establish a task group by October 2026 to collate good practice and develop a principles document providing guidance for insulin self-management by March 2028.
Response received 14 July 2026
The Community Nursing team within the national nursing directorate, will lead on and establish a short life task and finish group, to oversee delivery of both recommendations. Membership will be drawn from existing networks drawing on relevant key stakeholders including the Community and District Nursing Insulin Programme (CADNIP/) and Getting It Right First-Time representation. Delivery will focus on collating and synthesising existing good practice of models from across the country rather than commissioning new work. The established Community Nursing Clinical Reference Group and Community Nursing Fellows Alumni will support sense-checking and identification of exemplar models. The output will be the development of a principles document which will set out guidance to support integrated care boards and community providers with service models that empower and support people to manage insulin in community settings. In view of other relevant HSSIB recommendations related to supporting safe self-administration for patients in the community, for example for patients with a mental health problem, we will collaborate with other stakeholders to ensure strategic alignment and integration of related work to maximise impact and reduce risk of any duplication. Actions planned to deliver safety recommendation: Establish a short life task and finish group, by October 2026. Resources in place: This will be delivered by the Community Nursing and Primary Care Nursing Team, NHS England. Other dependencies identified: Strategic alignment and integration of related work with colleagues responsible for other HSSIB recommendations related to insulin in community. Collate and synthesise existing good practice, by June 2027. Develop and draft principles document providing guidance, by October 2027. Test the draft principles with several community providers prior to finalising and publication, by December 2027. Finalise the principles document, obtain internal sign-off incorporating output of recommendation 085, by March 2028. Response received on 14 July 2026 .
HSSIB recommends that NHS England/Department of Health and Social Care develops a tool for use in community settings to support the assessment of competency of patients, their families and carers to manage and administer insulin and care for people with diabetes. This should include recognition of a person’s circumstances, the impact of disabilities and impairments, and potential adjustments to support administration where safe to do so. This is to support consistency in how competency is assessed for the safe management of insulin within the context of modern diabetes care.
AI-generated response summary NHS England will establish a task group by October 2026 to develop and test a tool for assessing insulin management competency, with finalisation by March 2028.
Response received 14 July 2026
This recommendation will be overseen by the short life task and finish group, established to oversee delivery of both recommendations. Delivery will draw on existing frameworks and examples of best practice from professional bodies, diabetes charities and community providers, adapted, used, and endorsed rather than built from scratch. Patient, family and carer engagement and voice will be incorporated through existing stakeholder engagement mechanisms rather than separately commissioned co-production. The output will be a tool for use in community settings which will be incorporated into guidance and tested through the Clinical Reference Group. Actions planned to deliver safety recommendation: Establish a short life task and finish group, by October 2026. Resources in place: This will be delivered by the Community Nursing and Primary Care Nursing Team, NHS England. Other dependencies identified: Strategic alignment and integration of related work with colleagues responsible for other HSSIB recommendations related to insulin in community. Develop and test the tool through short life task and finish group, key stakeholders, and community providers, by October - December 2027. Incorporate patient, family, and carer voice through existing stakeholder engagement mechanisms. Finalise the tool and incorporate into guidance recommendation 084, obtain internal sign-off and publish, by March 2028. Response received on 14 July 2026.
Safety Observations
National bodies can improve patient safety by providing clarity on expectations around 1) how staff recognise that a patient’s mental capacity may be compromised in relation to decisions about their self-management of insulin, and 2) the undertaking of a mental capacity assessment by the most appropriate person. This should include clarification on the practical application of the Mental Capacity Act (2005) to situations where a patient’s capacity may fluctuate and where sharing confidential information to support patient safety may be appropriate.
HSSIB suggests safety learning for integrated care boards
HSSIB investigations include safety learning for integrated care boards where this may help organisations think about how to respond to a patient safety issue that relates to integrated care across a geographical footprint. Informed by the findings in this report, the investigation proposes the following safety learning.
Safety learning for integrated care boards ICB/2026/017:
HSSIB suggests that integrated care boards develop data-driven approaches to effectively identify the diversity of their populations’ characteristics and social circumstances, and use this data to support community providers to design services that empower and enable people to be involved in a patient’s care, including through supporting self-management of medications and conditions.
Safety learning for integrated care boards ICB/2026/018:
HSSIB suggests that integrated care boards, through future planning for neighbourhood health services, include consideration of how patients who may be at greater risk of harm from insulin administration due to their specific circumstances – for example co-existing disabilities, social isolation or receiving home-delivered medications – are proactively monitored to identify changes in their circumstances. This may include using technology such as remote monitoring.
Learning Prompts
How does your organisation create the conditions for staff to empower and enable patients, their families and carers – through a person-centred approach – to self-manage insulin where appropriate?
How does your organisation proactively identify the varying needs of people with diabetes in its local population, and ensure these are met to enable their management of insulin?
How does your organisation promote patient-centred care and facilitate self-care models that empower and enable patients, such as those with diabetes?
Does your organisation allocate specific resources to support patients, families and carers to develop competency to self-manage insulin, and ensure those resources are protected to empower and enable people?
How does your organisation ensure that staff supporting the development of a person’s competency have the required knowledge and skills to provide that training and education in relation to diabetes and insulin?
How does your organisation support staff to identify and code a person’s disabilities/impairments that may influence their competency to self-manage insulin, and ensure these are considered and adjusted for when deciding whether a person is competent?
Does your organisation have systems and processes to identify where patients have not requested their repeat medication prescription, or the frequency of the requests have changed, which may indicate changes in their circumstances?
How does your organisation ensure long-term condition reviews reliably take place for patients who may be at a higher risk of deterioration due to their circumstances, for example those with multiple long-term conditions?
How does your organisation identify and code patients – who may be more vulnerable to harm from insulin due to their circumstances – for increased monitoring? This may include patients who have their medications delivered to their home, who do not have family nearby, or who are housebound.
Does your organisation provide practical training and guidance to support staff to consider the mental capacity of patients to make decisions around their insulin when there are concerns capacity may be compromised?
Does your organisation provide practical guidance to staff to help identify when it is lawful, ethical and appropriate to share confidential information about a patient to mitigate risks to their safety, including with family members?
Does your organisation have accessible routes via which staff can seek urgent support when they are concerned a patient’s mental capacity to make decisions about their self-care may be compromised, particularly in high-risk situations?
How does your organisation support staff to develop ‘crisis plans’ for patients who self-manage insulin to protect their safety at a later point when their capacity to make decisions in relation to their care may change?