Wales's Diabetes Disgrace Week In Week Out

I feel that he was betrayed, and his children were betrayed. Tonight,

diabetes and the price of neglect. We thought, foolishly, that a

patient with diabetes in hospital would be safe. Clearly, he was not

say. Diabetes in Wales is a growing problem. New figures show it is not

being taken seriously enough. bottom line is it is a ticking

timebomb. At the numbers go up and the pressure increases, we hear

from nurses to say they can barely cope. They are moving us from task

to task instead of thinking logically about the best outcome

for patients. What happens when mistakes are made and questions

remain? I cannot understand why these nurses have not been held to

This is where memories of father are strongest. That is the back of

the car. My dress was made out of Liberty silk velvet. I've still got

it. Is that the old family together? Yes. They were married

for almost 60 years. They have five children and many grandchildren. A

noisy family? This is how you like to remember him. And that was one

of the final photographs. David was a Cambridge graduate and former

Royal Naval officer. He was a regional director for the Open

University before he retired. He was a character, by the sound of

things. Tell us about him. He was a funny man, very personable, good

looking, with a very nice speaking voice. He would speak like Richard

Burton. He was very hands-on, even in the mid- 1950s. He would take us

on expeditions. Magical mystery tours. We had one of those camper

vans, we would pile in the back and off we would go to the Norfolk

coast. He was also a diabetic. two diabetic. He was not diagnosed

until he was 60. He would call me a control freak. He had two bossy

nurses, a wife and a daughter. had no chance at all. He did not

like it because he liked good food and good wine. He found it a bit of

a drag. We would nag him about what he was eating, making sure he had

insulin on time. He used to say, if I need to spend the rest of my life

counting grapes, there's no point. We look after his diabetes for

decades. Yes. Me and my colleague. Without any hassle. In December

2008, David, who was by then 80, was taken ill. His wife did what

she could. His blood sugar was low, so I gave him thick brown bread and

honey sandwich and a drink of orange juice. He was obviously

unwell, so we sent for an ambulance. David was taken to Bronglais

Hospital in Aberystwyth. He had a suspected urinary tract infection.

Staff were told about his diabetes. We explained that his blood sugar

was a bit high because he had sudden attacks of hypoglycaemia

without any warning. We explain that he needed a snack, his routine,

how we managed 10 at home. There didn't seem to be any problems with

that. -- how we would manage him. He was all right, not confused,

unhappy at being in hospital but we said he would be home soon. He was

OK. We would take his drugs in, his record of his blood sugar as well.

When they visited the next day, David was awake and alert. They

were confident he would be home in time for Christmas. But in the

early hours of the following morning, Mrs Joseph received a

phone call from the ward. I was told his condition had deteriorated,

he had a respiratory arrest, then a cardiac arrest. They had

resuscitated him but his condition was very poor, and how long would I

be? If you fear the worst? I was expecting him to be dead when we

got there. What did you find? found him totally unresponsive,

obviously had been resuscitated, and obviously had some sort of

brain damage. He was not given the late-night snack he needed to keep

up his blood sugar level so. He became hypoglycaemic and suffered a

heart attack. We had looked after him beautifully all those years and

he had been in Bronglais Hospital less than 24 hours. I find that

absolutely unbelievable. It implies they were not observing him

properly. David Joseph died three months later in a nursing home.

Three years on, and after escaping ombudsman report, the family are

still fighting to uncover the full story. This is the first time that

David Joseph's widow has spoken out. The ombudsman's report was damning.

It highlighted failure after failure, he's one of them basic.

Taken together it contributed to his death. -- each one of them

basic. The family are angry at the way he was treated but even angrier

that diabetic care across Wales appears to be so inadequate. The

facts are startling. Almost 20% of hospital patients has diabetes. 30%

of these have experienced at least one mistake in medication. Almost

70% have not seen a member of a diabetes team. Even for a family

who know the system better than most, uncovering what has happened

was difficult. Meeting after meeting at a hospital only make

them more determined to carry on. It took a long time over three

years to get anywhere with the complaint, and that is not good.

Lots of people get fed up and stop but we were not going to get fed up

and stop. The family's complaint was upheld by the Ombudsman for

public services in Wales. He said David Joseph had received poor care

David Joseph had received poor care and was let down by the NHS. They

concluded if he had been given at bedtime snack and his blood sugar

nominated -- monitored properly, there was a reasonable chance he

would not have had a cardiac arrest. He said there was not enough

detailed information to show detailed information to show

exactly what happened, but found the failings had a contributory

effect on his deterioration and death. In her younger days, his

wife nursed at Addenbrooke's, one of the top hospitals in Britain.

Caring for diabetics was part of the routine. The concern deepened

when they saw his medical notes from Bronglais Hospital. This is

his blood sugar when he was admitted. This is his blood sugar

after his supper, on the evening he had a cardiac arrest. It rises

slightly. Yes. David's consultant ordered that his blood sugar level

should be monitored every four hours but this did not happen. It

appears that the blood sugar charge had been altered later. Then there

is a dramatic fall. Down to 1.3. That is catastrophically low. I

think somebody has put that in afterwards. They had not on the

blood sugar, they were meant to measure it every four hours and

they did not do it. That has been added in afterwards, and the

ombudsman agrees that you cannot place any reliance on that.

there no other way of interpreting that? I do not think so. It is not

just my interpretation, it is the interpretation of the medical

advisers and the ombudsman. family photocopied the chart and

produce it at one of the first meetings, where they discussed the

complaint. At a later meeting, the hospital admitted they had lost

their original copy. This photo copy is all that remains.

nursing staff were instructed to do the blood sugar every four hours

and this shows they were not doing it every four hours. The ombudsman

noted that there appears to be a false blood sugar reading added

retrospectively to the record. That meant he could have been

hypoglycaemic for eight hours, hypoglycaemic for eight hours,

which was unacceptable. He also said he took a very serious view of

attempts to force of by clinical records. It was something he had

criticised the health board for in a previous case. If it had been

more obvious which nurse was to blame, he would have referred the

matter. Peter Hickson is the chief executive of the health executive

of Wales. He is responsible for monitoring hospitals. He was asked

to consider the report. It is a to consider the report. It is a

catalogue of things done badly, and it was unavoidable consequence, a

sad one but avoidable. It was unnecessary. This was very basic

stuff. Left me feeling quite empty and a poll this had happened.

ombudsman expressed particular concern about diabetic care at

Bronglais Hospital. This was as recently as October. Evidence

gathered from healthcare support worker revealed of blood-sugar

monitoring was only carried out every six hours, regardless of

instructions from medical staff. The medical adviser said this was

an astonishing statement, and she had great concerns in relation to

the knowledge and skills about Diabetic monitoring of nurses on an

acute medical ward. It also undermined the claim that staff had

undergone training regarding its blood-sugar monitoring. Here in

Aberystwyth at local MP Office, Elizabeth Evans has been working

bid -- helping the Joseph family with their complaint. They had

enough about them as a family to make sure that they took photos of

the notes. Without that there would not be a case. Did it set off alarm

bells? At the time, no. I just thought it was an isolated case.

Since that time, other cases have come on my desk. Similar cases. Not

as extreme as Mr Joseph's case but certainly bad regarding the

treatment of people with diabetes. Other hospitals within the trust

have the same problems. Details about these cases have emerged in

the last 18 months. How worrying are these? Every case would go into

hospital for a different reason, so it was issues about fluid intake,

food, not eating, and any diabetic specialist will tell you that a

diabetic needs to eat. Were these elderly people? Yes. I did not know

this until you mentioned it. Very concerned, and I will ask questions

to other health boards about the level of complaints they get about

managing people with diabetes. Specifically, part of the follow up

will be making it known publicly we are doing this work, and asking

people to contact us if they have Mrs Joseph wants better care for

diabetics in hospitals. She said it ought to be a basic nursing

requirement. Nurses should know, if they are working on a medical ward,

they should know about the treatment of diabetes noofplt they

should know where ever they are working. Patients are not any more

admitted for assessment and treatment of their diabetes. They

are admitted for a variety of problems, right across the board.

Diabetes is a growing problem? Absolutely. The Royal College of

Nursing supports the campaign for greater awareness of diabetes.

Nicola is a full-time RCN official who visits members across the

country. The concerns we have are lack of education for patients,

lack of education for general staff. She say this is is one of a growing

list of issues facing overstretched faff staff. They feel devalued,

stressed, frustrated and they feel angry that they can't give their

best to their patients. That means that nurses can't deliver the care

that they know they should and care goes amiss. They are juggling from

task to task instead of thinking logically, what is the best outcome

for patients. Concern about the care of diabetics doesn't just

apply to hospitals. The fact, is diabetes is a life-long condition.

Diabetics are meant to be monitored carefully to avoid what can be

devastating complications. The fact, is in Wales that just doesn't

happen. There is loads of information. There are 160,000 die

bet nicks Wales. Each one should have nine important checks every

year. Covering eyes, feet and legs and blood pressure, cholesterol and

kidney function. 0% of adults with Type 1 and 43% with Type 2 simply

aren't getting those vital checks. A long time since I measured my

waist. It used to be a 24. I don't know what it is now! The human cost

is massive. It's a ticking time bomb. People are wondering around

with high blood sugars without realising it will cost them a

problem. It's the major problem of kidney failure, limb loss and

blindness in adults. Added to that you have vascular damage. The

damage of blood large blood vessels. Diabetes is a major cause of stroke

and heart attacks. You don't recover from that, generally

speaking. This year, among the Olympic celebrations around the

country a torch was held high for hope. Getting to carry the Olympic

Flame in front of my home city will be a memory I won't forget. A dream

come true for diabetic athlete Melanie Stephenson. You know,

throughout the day I was still doing my blood sugar checks. Every

time I did one I remembered, I'm here because I have diabetes,

Diabetes UK nominated me. This is my opportunity to raise awareness

that, yes, diabetes isn't a great thing to have, but you can overcome

that. Monitoring her blood sugar level is an essential part of life.

She depends on a pump which constantly regulates the flow of

insulin into hered abouty. It frees her from having to take frequent

injections. Melanie is supported by a diabetes clinic. One weekend her

pump broke and she had to use another hospital. I was an out-

patient for three days because nobody could help me on to the back

insulin. Nobody could tell me how much insulin we should be taking.

It didn't seem like we were talking the same language. Were you

surprised alt that? Surprised and frightened. You imagine hospitals

are safe places that are there to help you and fix you, really. They

cared and they wanted to help, but the knowledge wasn't there,

unfortunately. Back at Mavis' home they have unanswered question. Her

daughter is a senior specialist nurse for the health board. She

suspects the ward her father was brought into was under staff.

admitted they were one trained member of staff down on that night.

The om bus budsman noted: -- The om bus budsman noted: --

ombudsman noted: From your experience, what difference should

that have made to the operation of that have made to the operation of

the ward? Or might have done? very well to fill in these charts.

If you haven't people filling them in who are aware of the

significance of any changes, that usually means it should be a

trained member of nursing staff, they can't, you know, healthcare

support workers can't report back to the nurses in charge if their

patients have had any change in any of their vital signs. Nicola say as

worrying problem is that more specialist diabetic nurses are

being used to fill gaps on general wards. It means they have less time

to do their main job. specialist diabetic nurses and

specialist nurses being asked to come back to work ward shifts. That

is worrying, who looks after the case-load they have or the clinics

they have in the community? It has a knock-on effect for patients who

might have a delayed clinic appointment. We asked the health

boards in Wales to tell us how many specialist diabetic nurses are on

their staff. Across Wales there are only two more than four years ago.

An increase of just under 3%. The number of diabetics in Wales has

gone up by more than 20%. This worries Nicola, who is concerned

about the consequences for patients if there are fewer nurses to look

after them. It means that patients are more at risk of developing the

serious complications of vascular disease, cardiac and stroke as well

as amputation and blindness. Many of these patients are probably

frail and elderly. Specialist diabetic nurses are often relied

upon to show newly diagnosed patients how to manage their

condition. They look out for early signs of complications. Figures

from Diabetes UK show that in Wales 2% of diabetics receive this

support and and adequate information. It's another cause for

concern for the health inspectorate for Wales. That's wrong. Of course

it's wrong. That is missing an opportunity to help keep people

well. Actually, then help them avoid needing to come into hospital

at some point. Mrs Joseph, who trained as a nurse 60 years ago, is

concerned about levels of training and awareness in Wales today.

were all betrayed because we thought, foolishly, that a patient

with diabetes in hospital would be safe and, clearly, due to mistaken

ideas about the correct treatment of diabetics, he was not safe. It's

now, as we've said, too late for him, but things must improve to

make sure that no other patient is treated like this and suffers like

that. That no other family. Hywel Dda Health Board declined our

request for an interview in a The kd board also accepts the

ombudsman's findings. It has apologised to the Joseph family.

This health board is pioneering a scheme to reduce errors relating to

medication. Had you a low blood glucose a couple of days ago?

blood sugar was 2.3, I believe. They gave me two glucose tablets to

take. Hannah is on a surgical ward where around 20% of patients are

diabetic. It sounds to me as if you had the right treatment. Increasing

awardness of the treatment required for diabetics has reduced

medication errors in this area from 50% to 6%. The Board call it "their

think glucose campaign." on the trolley is the hypo box They are

kept on the same trolleys as blood glucose monitoring. If you do a

check and you find the blood glucose is low you can pick up the

hypo box and get the right treatment. It's important that we

go back to the patient and check that it has worked. Often, that was

the step that was missing before hand. Another invasion is new

insulin charts. How many units this morning? 10. Before Sometimes

people would write the number of insulin and put "u" instead of

"units" if you wrote 5U that could be mistaken for 50 because the

units is pre-printed. In one stroke we have God rid of some of the

insulin prescriptionerors that used to happen. They also have colour

coded monitoring charts that alert staff when blood sugar readings are

too high or too low. If it's in the red area, this know they should do

something. This is the only Welsh health board using "think glucose"

other areas are interested. Hywel Dda will be rolling it out in its

hospitals in the new year. Welcome news for the Joseph family. They

want someone to be held to account. More than three years on, no-one

has been disciplined for failing to check David's blood sugar levels

and apparently falsifying his records. It has taken us over three

years to get to this. The nurses were not interviewed until two

years after he died. That's not acceptable. I can't understand why

these nurses haven't been held to account and nobody has been

disciplined. The Hywel Dda Health Board say it is takes seriously any

allegation of breach of professional standards. Its

investigation is continuing. Since dealing with the Joseph case, and

the more recent complaint involving diabetes in her area, Liz Evans is

particularly concerned for diabetic patients who have no-one to speak

on their behalf. If I had a parent with diabetes, obviously I would

make sure, having dealt with the Joseph case, I would make sure that

the needs of my relative were met. The health board told us it didn't

have enough information to comment on the new cases. It said all

complaints are investigated thoroughly. Rowena Jones and her

sister have come to Cardiff for a meeting with the health

inspectorate for Wales. They want inspections of Welsh hospitals in

future to include key checks on all care for diabetic patients. A plan

is currently being drawn up. think the Joseph case has got

lessons for every health board and hospital in Wales and I think that

there are things, in terms of awareness, the "think glucose",

checking on training, checking on viability of expert advice in

hospitals, in hours and out of hours plus us, as ange external

inspectorate, checking those arrangements are in place, given

the scale of the issue and given the very dire consequences of it

not being looked after properly. I think this is fairly high up the

priorities, if not near the top. wanted to ask the Welsh Health

Minister Lesley Griffiths about the high level of medical errors

involving diabetics in Welsh hospitals. We wanted to ask her

about the poor number of health checks on diabetics across the

country. And, we wanted to ask why 98% of diabetics might not get the

education they need to manage their condition, but she refused to talk

to us. I'm not entirely surprised the Assembly didn't want to speak

to you. You tend not it speak to people if you have nothing positive

to say. As far as diabetic care goes there is very little the

Assembly can say that is positive. They have the new plan coming out.

It's the last chance to get it right. The current number of

diabetics in Wales is expected to rise to almost 300,000 by 2025. The

Welsh Government say it is will focus on this issue from the new

year, when it plans to begin gathering evidence that will

eventually lead to a diabetes delivery plan for Wales. Rowena has

just met with the health inspectorate for Wales. The family

is campaigning to improve care for all diabetics. They still want

someone held to account for what happened to their father.

personally, don't think it's up to the grieving family to be reporting

nursing staff to the NMMC. We are waiting to hear what the health

board is going to do, what the outcome of any discipline ri

proceedings is going to be. If they feel they will not take it any

further forward we will have to think about doing that as a family.

Mavis Joseph is still looking for peace of mind. Lovely blue sky.

That will only come with the answers to so many questions.

loved nursing. I loved the NHS, but... It's difficult to

understand... I still don't understand how they could have been