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recurance

Natalie Thornton

6 Feb 2017 · Coroner Simon Nelson · Manchester North

The coroner's concerns

  1. 1. inadequate monitoring and review of blood sugar levels

    “adequacy of the monitoring and review of blood sugar levels/data generated following the initial use of the pump provided by the Salford Royal Trust which provided [the deceased]'s equipment and had been caring for her over many years”
  2. 2. inconsistent support for insulin pump users

    “the level of support for insulin pump users nationally is variable”
  3. 3. absence of national consistency and minimum standards for insulin pump users

    “Whether the need for consistency and minimum standards should be addressed by Regional Centres of Excellence would be a matter for the Department to consider”

Responses

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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

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