Celebrating Diabetes Week 2026: from knowing what works to making it standard everywhere

The Health Service Safety Investigations Body (HSSIB) has published an important and timely report on insulin safety in hospital care. Its central message is clear: avoidable harm continues not because clinicians lack knowledge about safe insulin use, but because the health system has failed to consistently implement, monitor and take accountability for agreed standards of care.

Insulin related harm in hospital is not a new or poorly understood problem. Insulin is a high risk medicine and one of the most common causes of serious medication errors. National clinical standards for inpatient diabetes care are well established, and examples of excellent practice exist across the NHS. Yet the quality of care experienced by people with diabetes still varies significantly between hospitals, with predictable and preventable harm occurring too often.

HSSIB is well placed to make this assessment. Established in 2023 as an independent body with expertise in investigating the causes of harm across healthcare, it has already produced around 50 reports. While not a diabetes specialist organisation, it brings a system wide lens focused on safety, accountability and learning. Its findings carry weight and should trigger action.

Over the past year, HSSIB has engaged extensively with those responsible for delivering care, developing standards, regulating services and monitoring quality, alongside people with diabetes themselves. The resulting report is detailed but its conclusions are strikingly focused. The most important finding is that the NHS already understands why people with diabetes come to harm in hospital, and in many cases how that harm could be avoided. What is missing is a reliable national mechanism to ensure that standards are applied uniformly, and to identify and address poor care when it occurs.
For people with diabetes, admission to hospital can be particularly challenging. Insulin treatment is highly individualised, and many patients have significant expertise in managing their own condition. In hospital, established routines are often disrupted and specialist input becomes critical. Yet many people report encountering teams with limited expertise in diabetes, leading to treatment decisions they feel are unsafe. Where no system exists to monitor quality consistently, unacceptable variation can persist unseen.

Notably, HSSIB does not attempt to redefine what good care looks like. That work has already been done. Clinical standards are clearly articulated by the Joint British Diabetes Societies Inpatient Care Group, and the Royal College of Physicians, working with Diabetes UK, has developed the Diabetes Care Accreditation Programme (DCAP) to support and assess delivery of those standards in practice.

The challenge is no longer guidance, but accountability. NHS England has recently been developing new approaches to monitoring inpatient diabetes care, expanding existing audits beyond harm to include measures of day to day care and patient experience. The opportunity now is to align this work with DCAP, creating a coherent national framework that enables hospitals to demonstrate high quality care and the system to identify variation transparently.

The next step is clear: adopting the DCAP nationally would help the NHS deliver consistently high-quality care for every patient. DCAP provides a practical, evidence-based framework to help services implement, measure and improve care. It’s about turning what we know works into everyday practice.

This HSSIB report is a reminder that patient safety depends not on repeated guidance, but on reliable delivery. We already know what good inpatient diabetes care looks like. The task now is to ensure it is consistently delivered, monitored and owned across the NHS, so that preventable harm becomes the exception rather than the norm.