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The term ‘neighbourhood’ when used in reference to health and care, often suggests a collective, cross-sector and/or community approach. A recent Digital Care Hub webinar investigated the latest updates connected to the NHS / DHSC’s Neighbourhood Heath Policy, what it might mean for adult social care providers, and what’s needed to unlock the digital systems and processes that will help make it a reality. If you missed it, the webinar can be viewed below.

The massive roll-out of new and repurposed medicines in low-income and middle-income countries (LMICs) highlights the need for more efficient pharmacovigilance systems, including use of digital technologies. This study reports a large pragmatic cluster-randomised controlled trial to assess the effectiveness of the smartphone app Med Safety in improving suspected adverse drug reaction (ADR) reporting by healthcare workers to Uganda's National Pharmacovigilance Centre. Between Aug 11, 2020 and Nov 1, 2022, 367 clusters (healthcare facilities providing dolutegravir-based combination antiretroviral therapy in Uganda) received the allocated intervention (184 in the intervention group and 183 in the control group), with 2464 health-care workers (1211 in the intervention group and 1253 in the control group). In the intervention group, health-care workers received pharmacist-delivered training in Med Safety and traditional ADR reporting methods. The control group received the same training as the intervention group except for Med Safety training. The primary outcome was the cluster-level ADR reporting rate at the end of follow-up (at least 12 months) and was analysed in all sites that received the allocated intervention. Med Safety use was found to increase ADR reporting rates among health-care workers in Uganda, particularly non-serious and dolutegravir-related ADRs. These findings suggest that integrating digital technologies into pharmacovigilance systems could strengthen drug-safety monitoring in Uganda and other LMICs.

This Health Services Safety Investigation Body (HSSIB) report is the second in a series considering the self-administration of insulin by people with diabetes mellitus (diabetes) in community settings. Many people with diabetes manage and administer their own insulin, either by injection or using a combined monitor/pump device (a hybrid closed loop system). However, a disability or impairment may affect their ability to safely manage their own insulin if they are not supported. This can lead to short-term and long-term health problems, which can be life threatening. HSSIB identified incidents where a person with diabetes or their family/carer had administered insulin incorrectly (the patient safety issue of focus). In these incidents, a disability – such as a visual or memory problem – had influenced how someone had administered insulin. The investigation explored the following areas in relation to the patient safety issue: supporting the development of people’s competency – that is, their skills, experience, knowledge and ability – to manage insulin recognising and responding when people’s circumstances change, such as deterioration in a disability assessment of people’s mental capacity to make decisions in relation to insulin. Findings People with diabetes (who require insulin) are at risk of harm through the administration of insulin when pre-existing or new disabilities/impairments have not been recognised or adjusted for. People are not always empowered to become competent to manage their insulin, with assumptions made that a person is not competent to do so because of a disability/impairment. Supporting people to safely self-manage their health, including insulin, requires integrated working across community services. Where this is limited, such as due to resource challenges or limited collaboration, people are put at risk. Efforts to empower and enable people to self-manage insulin are affected by the competing demands on, and the capacity and accessibility of the community services that provide this type of support. Designated and protected resource aimed at supporting the development of insulin self-management skills have shown benefits for patient experience and have reduced demand on community services. There is no national competency framework for the management of insulin by patients and families that supports community services to identify and make reasonable adjustments for a disability/impairment. Administration of insulin by staff in care homes (delegated administration) may reduce demand on community teams but is limited by barriers to implementation, including high turnover of care home staff. Some people with type 2 diabetes may be prescribed insulin without first optimising other diabetes treatments and/or exploring preferences. This means a person may be exposed to the risks of insulin unnecessarily. There are people with diabetes (who require insulin) whose circumstances mean they are not monitored for changes in a disability/impairment, including via long-term condition reviews in general practice. People may not engage with healthcare services to enable the regular monitoring of their condition. Engagement is affected by the ability of services to meet patient needs but may also represent other situations that require a response, such as in relation to patient safeguarding. Electronic systems in general practice may not alert users when people have not requested repeat prescriptions of insulin, removing a potential opportunity to identify patients who need support. Diabetes technology, such as insulin pen devices, are not always designed in a way that supports people to administer insulin when they have a disability/impairment, such as visual impairment or problems with dexterity. There are concerns about the future competence of the healthcare workforce to support the increasing numbers of people with hybrid closed loop systems. Healthcare workers may not identify when a patient’s mental capacity to make decisions in relation to their insulin may be compromised, meaning a more in-depth assessment in line with the Mental Capacity Act (2005) may not occur. Limited education and practical support for application of the Mental Capacity Act (2005) by healthcare staff means its principles are sometimes misunderstood. Patients with diabetes (who require insulin) and who experience fluctuations in their mental capacity, are at risk of harm when services do not proactively plan for a time when the patient may lose the ability to manage their insulin safely. HSSIB makes the following 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. 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. HSSIB makes the following safety observation 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. 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. 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. Local-level learning HSSIB investigations include local-level learning where this may help providers/organisations respond to a patient safety issue at the local level. Informed by the findings in this report, the investigation shares the following local-level learning. 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?

The role of communities in improving health is receiving increasing attention from policy makers and NHS leaders. An important part of this involves using ‘strength-based’ or ‘asset-based’ approaches, which nurture the strengths of individuals and communities to build independence and improve health. Since 2011, Wigan Council has embarked on a major process of change involving moving towards asset-based working at scale, empowering communities through a ‘citizen-led’ approach to public health and creating a culture which permits staff to redesign how they work in response to the needs of individuals and communities. At the heart of this is an attempt to strike a new relationship between public services and local people that has become known as the ‘Wigan Deal’. To understand the approach Wigan Council and its partners have taken, the King's Fund interviewed a wide range of people over the course of seven days. They visited a number of key sites across Wigan, speaking to frontline staff, users of services, the voluntary sector and citizens of Wigan as well as leaders in the system. This fieldwork formed the basis of a report examining how and why the Wigan Deal was developed, how it has been put into practice, and what others might learn from it.

How do you create a strong foundation of primary and community care in neighbourhoods? The King's Fund brought together senior leaders from across health and care in England and Singapore to discuss the shift to population health, prevention and neighbourhood-based health and care.

The Health Services Safety Investigations Body (HSSIB) engaged with a wide range of stakeholders, including clinicians and national leads, to learn more about the issues surrounding learning from patient safety events in mental health settings and to identify areas where an investigation could focus to help improve patient safety. Although suicide has been the focus of extensive national work, it has persisted as a safety risk. The themes from incidents and complaints have remained the same over time. Evidence from the intelligence gathered suggests that greater insight into the challenges faced at an organisational level when a service user has attempted suicide, or taken their life, would be helpful. To support NHS organisations and local investigation staff, HSSIB identified an opportunity to model approaches to patient safety incidents investigations (PSIIs) under the NHS Patient Safety Incident Response Framework (PSIRF). Stakeholders told HSSIB that this would help to increase local learning and provide examples of how PSIRF tools can be used to improve investigations. HSSIB has also used this opportunity to identify learning that may help to improve how PSIRF can support staff in carrying out incident investigations. This investigation has used the PSII report template and PSIRF tools to investigate an attempted suicide in the community mental health setting. Findings and areas for improvement are listed for the organisations that were involved in this incident. However, the learning may be relevant to other organisations. Summary of key findings The investigation found that: The Service User’s attempt to end his life was not expected by the mental health staff supporting him. The change to his medication meant it was a potentially vulnerable time for the Service User's mental health. This was despite him having a safety plan for how to seek help if he felt overwhelmed and planned monitoring check-ins in line with local procedure. The Service User’s case was complex and challenging; his mental ill-health, drug and alcohol use are likely to have impacted on his ability to reason and make informed decisions. Therefore, sharing of information across and between healthcare services was important to facilitate personalised care planning. Limited sharing of, and lack of ready access to, information about the Service User and his past mental health history impacted on the CMHS’s ability to provide effective and timely care. The Service User needed a tailored approach with reasonable adjustments to maximise his engagement with mental health services; there was a delay in his needs being identified and acted on. There was limited understanding and awareness by some staff of whether mental health medication can be offered to service users with mental health issues and concurrent alcohol use. Staff worked in a service that was overstretched and they had to make decisions about managing service user needs, service demand, and risk and safety, within limited resources. The demand for CMHT services exceeded the available capacity, impacting both service users and staff. Staff did not have the dedicated time and space to process and deal with distress they encountered as part of their daily work caused by incidents of patient harm. There are challenges to delivering the national ambition to provide a community focused model of care, many of which the mental health trust has limited or no control over. Summary of areas for improvement The investigation identified four areas of improvement which the mental health trust could develop safety actions to address. Area of improvement 1: Making information about service users easily available and accessible across providers to support effective initial engagement and decision making. Area of improvement 2: Early exploration of adjustments that individual service users might need to engage in the triage and referral processes. Area of improvement 3: Staff knowledge and insight into how community mental health services can support service users who may require prescription medication and who use drugs and/or alcohol. Area of improvement 4: Organisational support for protected time, resources and assistance for staff to mitigate and respond to the distress and demands they experience in their role.

Neighbourhood health centres (NHCs) support the NHS shift towards prevention, early intervention and more integrated care delivered closer to home. The Neighbourhood health centre guidance for regions and integrated care boards sets out the practical planning instructions for developing NHCs in the current planning period. The Neighbourhood health centres: design and performance specification supports the planning and delivery of new‑build neighbourhood health centres.

The General Practice Requests for Advice and Guidance (A&G) is an enhanced service within the NHS that supports general practice teams to seek specialist advice from secondary care before or instead of making a planned care referral. This service is designed to support the Government's commitment to move more care from secondary into community settings. It aims to ensure patients receive care in the right place at the right time via the use of specialist advice and guidance by general practice. Participation is optional but practice that have signed up are eligible to claim payment for pre-referral A&G requests made since 1 April 2025.  The Royal College of Practitioners (RCGP) proposes 6 key recommendations for the use of A&G which includes shared clinical risk between primary and secondary care and aims to ensure that advice and guidance continues as one option for clinicians within a referral process and must not be mandated. Further support for collaboration between primary and secondary care is essential to enable the backlog of care exacerbated as a result of the pandemic to be managed and streamline patient care. If work is to be transferred from secondary to primary care, via A&G, then resource (time, money and people) must follow the patient and not stay in secondary care. A&G should be optional and not mandated. Other tools to promote closer working between primary and secondary care aiming to streamline patient care are available and should be considered by providers as alternatives, allowing choice. These include direct telephone calls, emails, teledermatology and commercial apps that are able to connect primary and secondary care. Clinical care governance and risk must be shared between primary and secondary care during A&G conversations, and this must be understood by all clinicians and their patients when A&G is used. When using A&G, all clinicians must uphold the standards of good medical record keeping as per GMC advice, documenting decisions and actions, identifying who has made the decisions and is agreeing with the actions, in the patient clinical record. This should apply to both primary and secondary care and not rely solely on primary care updating the clinical records.

The government has published its much-awaited Neighbourhood Health Framework. It sets out in new detail what neighbourhood health aims to do and how this will be achieved, building on the 10 Year Health Plan, the Neighbourhood health guidelines 2025/26 and the Medium Term Planning Framework.  The framework describes neighbourhood health as putting the person at the centre of how local services are organised and delivered – including GP and community services, urgent care and outpatients, as well as services commissioned by local authorities such as social care and public health.   The new guidance brings some long-awaited clarity to commissioners and providers about what neighbourhood health should deliver. There is much to welcome. But questions remain around whether targets can ease pressures on the acute sector as well as improve patient care and experience; whether focus can be maintained on long term population health priorities among a plethora of specific shorter term delivery goals; whether permissiveness in designing local services and rigid structures can coexist; and, fundamentally, whether integrated care boards (ICBs) and other organisations have the capacity to action it all.  In this King's Fund article, experts set out their more detailed analysis of the framework. They consider the parts to celebrate, the aspects that raise some concerns, what’s missing, and the questions that remain outstanding.  

Every year millions of children in England spend time in hospital. Most children are in hospital only for a short period, often just after they are born or during brief periods of illness. However, for a number of children, hospital becomes a place they spend months and sometimes years of their lives. For the first time, this report shows how long children spend in hospital over their childhoods through new analysis of NHS data. This report sets out why children are waiting to be discharged and what their experience of delayed discharge is like. For some children, time they spend in hospital waiting to be discharged is avoidable. That is particularly true for two groups of children. First, children with serious and complex medical needs. While advances in modern medicine are making a monumental difference in giving them a stronger chance in life, the systems that surround these children – community and primary care, children’s social care, palliative care, housing and education – have not kept pace. The Children’s Commissioner’s office has focused on what this means for children who are waiting in hospital, ready to be discharged. Second, for some children admitted to hospital with social, emotional, behavioural and/or mental health needs. For children admitted with these needs but who do not meet the criteria for inpatient mental health services, their experience waiting in hospital for the right care and support in the community is similarly rooted in challenges facing health, social care and education which has resulted in them being let down, and being admitted to hospital in crisis - waiting for the right therapeutic support in the community. This report brings together data on how long children spend in hospital across their childhoods, alongside the voices and experiences of families, health and care professionals working in hospitals, hospices, community nursing teams and care providers. It sets out the issues facing children whose hospitals stays are being prolonged or more frequent because the support they need to be in the community is not in place.

The 10 Year Health Plan for England envisions a major shift from hospital to community, towards the creation of a Neighbourhood Health Service. This is intended to bring care into local communities, convene professionals into patient-centred teams and end fragmentation. This policy paper, published by the Department of Health and Social Care, sets out how Integrated Care Boards (ICBs), local authorities, health and wellbeing boards and other partners should create and deliver neighbourhood health services. Neighbourhood health puts the person at the centre of how we deliver their health and care by organising services so they can work together to serve a defined population. This policy paper describes the aims of this approach as follows: Improve people’s health and care outcomes, reduce health inequalities and help them stay well at home This will be done by: focusing on prevention and proactive care management, including using data to effectively manage risk and prevent escalation strengthening primary and community services working better with specialists traditionally based in hospitals, public health, adult and children’s social care, VCSEs and other partners. Organise services around the person with more convenient, personalised and joined-up care Orientate services around a person’s needs, rather than organisational convenience. A strong digital approach will be critical to this. This includes: improving access to care (by phone, online or in person) moving more outpatient care from hospitals into neighbourhoods improving continuity of care for those with longer-term needs more effectively co-ordinating services for those with the most complex needs, for example, those at end of life. Reduce pressure on more acute services - including hospitals and care homes This will be done by: using effective neighbourhood working to decrease avoidable hospital admissions or attendances and facilitate timely discharge reducing the de-conditioning that happens to many people when they spend time in hospital reducing avoidable care home admissions ensuring acute services are focused on those who need them most. Cut waste and duplication This will be done by: integrating services across health, local government and wider partners making full use of digital opportunities ensuring the NHS is more sustainable.

This Health Services Safety Investigations Body (HSSIB) report is the first in a series considering the self-administration of insulin by people with diabetes mellitus (diabetes) in community settings. It focuses on adults with a mental health problem who are known to or under the care of secondary mental health services (specialist services provided in the community), who have been harmed when they have not self-administered their prescribed insulin as intended – this is referred to as the patient safety issue in this report. People have come to harm or have died as a result of self-administering too much insulin and/or not self-administering insulin when it is needed. Hearing the experiences of all those affected led the investigation to examine the following in relation to the patient safety issue: collaboration between mental health and specialist diabetes services care for patients experiencing a mental health crisis access to insulin devices and technology. Findings Findings related to collaboration between mental health and specialist diabetes services Patients with a mental health problem and diabetes (requiring treatment with insulin) in the community are not always under the care of specialist diabetes services when this would be expected in their care (for example patients with type 1 diabetes). Patients have been discharged from specialist diabetes services after missing one or more appointments (‘did not attend’). Patients may be discharged without consideration of their circumstances and clinical risk. Patients have disengaged from specialist diabetes services when adjustments have not been made for their mental health needs. Services had limited access to support from specialist mental health teams. Community mental health teams feel responsible for their patients’ diabetes care when they are not under the care of a specialist diabetes service. Teams have limited routes through which to access support around insulin management. There is variable integration of mental health and specialist diabetes services in different parts of the country. This is despite recognition of the disconnect between services and the risks to patient safety and physical health. Digital integration between mental health and specialist diabetes services is also variable. This has created barriers to information sharing and has contributed to patient safety incidents. Integrated care boards face barriers – such as resource limitations, workforce shortages and separated policy teams – to developing integrated arrangements between mental health and specialist diabetes services. There are unclear national plans for the long-term integration of mental health and physical health services, with limited national collaboration between relevant policy teams to address the issues. There continues to be no effective mechanism to allow regulatory oversight of care pathways that span different providers/organisations, such as for integrated mental health and diabetes care. The combination of type 1 diabetes and disordered eating (T1DE) contributes to significant patient harm. There are varying views about whether T1DE is a specific condition, and research gaps around the identification of and care for patients with T1DE. Long-term funding for T1DE services is at risk due to factors including their cost, highly specialist nature and concerns about limiting access to services for other people with diabetes and a mental health problem. People experiencing homelessness face challenges accessing the support they need for their mental health and diabetes. Limited data on the need for services influences investment, and prejudice may be a factor. Findings related to access to insulin devices and technology There are no insulin pen devices designed in such a way that would prevent a patient from intentionally self-administering excess insulin. Limitations in data collected by manufacturers and national organisations means the patient safety issue in this investigation may not be apparent to manufacturers. Changes to insulin pen device design in response to patient safety issues may not be considered when the issues have arisen through use of the device outside of its intended purpose. Some patients may be being disadvantaged by not being considered for continuous glucose monitoring or hybrid closed loop systems due to their mental health problem. Findings related to care for patients experiencing a mental health crisis Community mental health teams face barriers that prevent them from forming therapeutic relationships with patients and therefore the making of safety plans should the patient feel the urge to self-harm. People with a diagnosis of personality disorder face challenges accessing specialist mental health services that are able to meet their specific needs. Mental health teams may not fully recognise the risks of self-harm associated with access to different types of insulin. This is not consistently covered in pre-registration mental health practitioner training. Care planning does not always consider the safeguarding of patients who experience rapid and extreme fluctuations in their emotions and mental capacity, placing them at risk of self-harm. Information supportive of a patient’s safety may be withheld from their family – as a result of the patient declining sharing – without staff considering the context, and the patient's mental capacity and whether they recognise the potential benefits and risks of the decision. HSSIB makes the following safety recommendations Safety recommendation R/2026/073: HSSIB recommends that NHS England/Department of Health and Social Care develops a strategy for improving collaboration between mental health teams and specialist diabetes services, that includes consideration of responsibilities for integrated working at national, regional and local levels. This is to support future integration of services that will benefit all patients with mental health and diabetes care needs, including patients who are required to self-administer insulin and patients with type 1 diabetes and disordered eating. Safety recommendation R/2026/074: HSSIB recommends that the National Institute for Health and Care Research, in collaboration with relevant research and policy stakeholders: maps the knowledge gaps surrounding type 1 diabetes and disordered eating (including those identified in this investigation) assesses the priority and feasibility of commissioning research to help address those gaps. This is to help develop new knowledge to inform future decisions for the delivery of safe and effective care for this group of patients. Safety recommendation R/2026/075: HSSIB recommends that Royal College of Psychiatrists, through collaboration with relevant stakeholders, develops a strategy that: supports consistent recognition of patients with type 1 diabetes and evidence of disordered eating; and identifies associated care responsibilities for providers of mental and physical health services. This is to help improve the NHS’s recognition of patients who are affected and to support decisions around the commissioning of services. HSSIB makes the following safety observations Safety observation O/2026/081: Organisations involved in the provision of undergraduate and pre-registration education and preceptorship/induction programmes can improve patient safety by ensuring that staff have knowledge of diabetes, an understanding of how and why insulin is a vital treatment for many people with diabetes, and the risks that the use and misuse of insulin can present for patients with a mental health problem. Safety observation O/2026/082: Organisations involved in the manufacture of insulin pen devices used by the NHS can improve patient safety by: understanding where devices are being used outside of their intended purpose exploring the potential to design devices that would reduce the risk of intentional overdose of insulin for self-harm. HSSIB suggests safety learning for integrated care boards HSSIB investigations include safety learning for integrated care boards where this may support the response to a patient safety issue across a geographical footprint. Safety learning for integrated care boards ICB/2026/014: HSSIB suggests that integrated care boards formalise collaborations between mental health and specialist diabetes services in their local systems. Through co-production with people with lived experience, this should look to include: care arrangements for people with a mental health problem and diabetes, particularly for those who require insulin routes for community mental health teams to access advice where their patients have diabetes and access to insulin routes for diabetes specialist teams to seek advice from mental health teams about reasonable adjustments for patients under the care of outpatient clinics enablement of interoperability between electronic systems to support information sharing. Safety learning for integrated care boards ICB/2026/015: HSSIB suggests that integrated care boards develop data-driven approaches for the understanding of local need to inform decisions about services for patients who have been identified as marginalised in this investigation. These are patients with: co-existing mental health and long-term physical health needs (diabetes), including those with a diagnosed personality disorder and/or experiencing homelessness type 1 diabetes and disordered eating. Local-level learning HSSIB investigations include local-level learning where this may help providers/organisations respond to a patient safety issue at the local level. For organisations providing mental health and/or specialist diabetes services: Does your organisation have a specific job role with responsibility for cross-organisational care pathways to ensure the holistic needs of patients, including those with mental health problems and diabetes, are met? How does your organisation ensure information about patients is available to other providers of care when required, for example to mental health teams about a patient’s diabetes care? How does your organisation ensure staff are aware of their responsibilities to report incidents associated with diabetes medication and technology, including to manufacturers and the Medicines and Healthcare products Regulatory Agency? Does your organisation have a process for identifying and appropriately supporting patients with type 1 diabetes who also have evidence of disordered eating? For organisations providing specialist diabetes services: How does your organisation ensure patients with a mental health problem are not being discharged from clinics following a ‘did not attend’ without consideration of their circumstances and risks to their safety? Do your staff recognise the need to make reasonable adjustments for patients, including for those with a mental health problem, to support access to care? Does your organisation have a liaison psychiatry service that supports inpatient and outpatient services for people with a mental health problem? Does your organisation have clear routes via which services can seek support from specialists in mental health if a patient is found to be experiencing a crisis? How does your organisation identify patients who have had recurrent admissions with diabetic ketoacidosis or hypoglycaemia, and support staff to consider whether these patient require input from mental health services? How does your organisation ensure patients with a mental health problem, who meet the criteria for diabetes technology, are receiving support to access it and are not being discriminated against because of their mental health problem? For organisations providing mental health services: How does your organisation ensure staff working in the community have access to advice about a patient’s physical health, including specialist advice for conditions such as diabetes requiring treatment with insulin? How does your organisation keep staff up-to-date about the different types of insulin used in the NHS and their onset times to ensure this is considered as part of assessment of a patient’s risk of self-harm? How does your organisation enable staff to work therapeutically with patients to support them to develop safety plans which include consideration of the risks associated with insulin? How does your organisation support multidisciplinary discussion in discharge planning that recognises the circumstances a patient is being discharged into to ensure they are appropriate for their mental and physical health needs? How does your organisation support staff to make assessments under the Mental Capacity Act, with particular consideration of whether the patient can use and weigh information as part of their decision making? Does your organisation provide services that effectively meet the needs of people with rapidly fluctuating and extreme emotions, and that consider how best to support these patients when they are unable to make decisions to keep themselves safe? Do your staff recognise the importance of family involvement in patient care, and where the patient refuses this, do staff ensure the reasons for refusal and the potential ramifications are explored and it is appropriately revisited over time? How does your organisation support staff to not make assumptions about patients based on their circumstances and characteristics?