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Hospitals should provide the services and resources required for the management of the surgical patient with diabetes, including explicit managerial and clinical policies.^33,269,270

Hospitals should consider appointing a lead anaesthetist for diabetes with appropriate time for the role identified in their job plan.²⁷⁰

Hospitals should have clinical guidelines, including:³⁴

involving patients in the management of their own diabetes

• ensuring that surgical patients with diabetes have an individualised explicit plan for the management their diabetes during periods of starvation and surgical stress; this may require the involvement of senior anaesthetic staff and the availability of equipment to continue or institute variable rate intravenous...

In patients with learning disabilities or special needs, there should be close co-operation with other specialists. A learning disability liaison nurse could be available to support patients and carers while attending the hospital either for outpatients, day surgery or as inpatients. If patients lack capacity and are unaccompanied, then the involvement of an independent mental capacity advocate (IMCA) should be...

Departments should have a policy on how to care for patients with additional needs including those covered under the Equality Act, and consider appointing an assigned lead anaesthetist with time in their job plan for the role.^274,275 The policy should incorporate preassessment, deprivation of liberty assessment, consent, pathways to minimise anxiety and considerations for analgesia and discharge planning.²⁸¹

Some patients who are unable to leave their homes and have difficulty in accessing primary or secondary care may benefit from a home visit for their preoperative assessment and preparation. The same may apply to prisoners detained in HM Prison Service.

Translators or interpreters should be available for patients who do not speak or understand English and those who use sign language. Written information also needs to be available in different languages.

Training of anaesthetists includes attaining the competency to perform medical assessment of patients prior to anaesthesia and surgery or other procedures.276

The preoperative assessment service should enable multidisciplinary training for medical students, nurses, specialist doctors in training, allied health professionals, pharmacists and pharmacy technicians. Educational materials are available to facilitate this training.⁹² Schools of anaesthesia should give consideration to establishing specific modules in preoperative assessment and perioperative medicine for senior trainees.

Preoperative and perioperative educational resources should be made available to general practitioners and primary care staff who are instrumental in ‘first contact’ patient consultations prior to secondary care referral. This facilitates robust cross-boundary working relationships and agreed ‘fitness for referral’ protocols, while minimising delays in the patient journey.