A timely reminder appeared on the BBC website today in the form of this piece bearing the title Diabetics’ access to blood glucose test strips ‘restricted’, which led me to the Diabetes UK report Access to test strips – A postcode lottery? (Aug 2013) . The Daily Record from your short time in Care UK’s Lennox House care home featured heavily at the NMC hearings that started in February 2012 and concluded in April 2013.
One entry in the Daily Records was a strange entry, written almost as a post-script afterthought once you’d been admitted to hospital in a diabetic coma.
That entry (unsigned, by the way) gives the results of a urine test, and alongside is bracketed the following: “There was no available glucose strip since the GP does not prescribe according to Deputy Manager & Home Manager”.
Does that not appear to be a peculiar entry in a record of care? It almost looks like an attempt to validate the absence of care. The full urine test results were indeed alarming. I’m not a medic but it didn’t take me long to work out which parts of the results should have rung bells. But the care home didn’t find them sufficiently alarming to call an ambulance, because they waited another 15 hours before doing so, by which time you were in a desperate state, with spasms lasting nearly half an hour noted hours before an ambulance was called.
When I arrived in A&E, soon after your arrival there, I was asked to explain how your diabetes had come to be ‘so out of control’. I didn’t know that it was out of control, of course, but the hospital for some reason thought that you lived with me and that I was responsible for your care. Not so.
When I asked the manager to explain to me what that entry in the Daily Record meant, she said that the GP refused to prescribe test strips for the care home, and that Care UK also refused to supply them. That’s the point at which I offered to pay for a full year’s supply for the care home so that no other person would suffer the way you did.
During the investigation into what happened with your care, the investigators were told that test strips had been bought from a well-known chain of chemists – but no evidence could be found to support that. Not even a petty cash record.
However, at the hearings at the NMC, there were other and different rationales put forward. One proposed by the manager was that your diabetes was ‘diet controlled’ and not medication-controlled. Not so. When she saw you, allegedly just before she left the building, you were “warm and pink” and you gave no indication of distress, pain or suffering. What a shame she didn’t have the time to act on your urine test result, that she was surely informed of before leaving the building.
You were not in a position to monitor your own glucose levels. Vascular dementia made that impossible for you, and in any case your previous GP (not the one providing services to Lennox House) had monitored you regularly, as had your clinic appointment regime. You never missed an appointment. It was the responsibility of the care home to monitor your diabetes – that’s what care homes are supposed to do. Care.
Another memory has been brought forward by today’s reports. The GMC (General Medical Council) was informed by the GP involved that she had no knowledge that you had diabetes, and that had she known she would have carried out the required test and had you admitted to hospital. The NMC was told a very different story by the nurses involved, namely that the GP had indeed been informed of your diabetes when she visited you (and prescribed an antibiotic for a suspected UTI). They can’t all be right, can they?
Again at the NMC hearings, mention was made by the manager and other nurses and their representatives that there had been no training in diabetes at Lennox House, before your arrival there. It was even said that there was no specific training in diabetes given for a couple of years after your death. Not so. Would nurses never have heard of Hyperosmolar Hyperglycaemic State (HHS) (previously called Hyperglycaemic Hyperosmolar Non-ketotic Coma (HONK) or Diabetic Ketoacidosis (DKA) ?
Diabetes UK calls the restricting of access to test strips a lottery. You definitely did not win the lottery in Care UK’s Lennox House care home where your diabetes was neither monitored nor tested, whether by strip or by other means.
Barbara Young, Diabetes UK Chief Executive, said “Rationing test strips to save money does not make any sense, because it is putting people at increased risk of complications that are hugely expensive to treat.”
You’d be a fool to argue with that.
I sincerely hope that Home Secretary Theresa May, recently diagnosed with diabetes, will not find her access restricted. If she does have that experience, she will no doubt take steps to ensure the restrictions are lifted.