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Clare HortonClaire BurkeSarah Johnson

Falling ill is a very common occurrence. Luckily for most it is a short-term, self-limited thing. But exactly what you're meant to do about it or how you're meant to behave are more complicated concerns in modern times

I've been ill lately. I used to rarely get ill, probably because of my job embalming cadavers for a medical school. Handling decaying bodies on a daily basis was somewhat bleak, but useful for maintaining a robust immune system.

Now I have a son who goes to nursery. As anyone with a child in nursery will tell you, they tend to bring things home; daily reports, little pictures or things they've made for you, and of course a generous selection of horrible germs and diseases.

It's quite nostalgic; most of the bugs he brings home are ones I remember from my own childhood, involving snot, varying coughs and all manner of dribbling. It's a bit like those "I love the 80s" programmes, but with pestilence rather than big hair and legwarmers. It makes sense; you get a large number of humans from varying backgrounds with underdeveloped immune systems in one place, it's going to provide ideal conditions for the constant spread of sickness. Parents then catch these as well.

Ergo, you end up being ill on a regular basis. But as annoying as this is, another issue is that the appropriate way to behave when temporarily ill has gotten somewhat confusing.

It is a time of constant demonising of the disabled and chronically ill and a worryingly over-burdened NHS. If you care about those things (admittedly, many don't) then the thought of adding your own temporary problems to the pile feels wrong. I know I'm entitled to use the NHS, that's the point of it, but when you're regularly told it's strained to breaking point, I'd prefer to avoid adding to the pressure. I'm entitled to use my local park too, but if it was on fire while infested with rabid wolves, I'd go somewhere else for a Sunday stroll.

And even if I did see my GP, what could they do? Prescribe antibiotics? Even that's potentially a bad idea.

The alternative here is treating yourself. We have easy access to cheap medication and the accumulated medical knowledge of human society. Maybe we should just take care of our own maladies? Except this is a dubious practice; those of us who self-diagnose online tend to latch on to the worst diagnoses; if you're already worried enough to check your symptoms with Dr Google, you'll likely display confirmation bias for the worst potential outcomes.

Maybe it's best to just wait it out until your illness passes. Although if you're lucky enough to be employed, this means taking time off, and it's hard to do that without a doctor's note, which you probably don't have (see above). You may get away without one, but is it worth the risk? The economy is a mess, every business is cutting so many corners they're all perfect circles by now, and the news is filled with rampant unemployment and persistent attacks on "scroungers". It's a brave person who's willing to risk their job in these conditions.

I had to go to work despite a particularly vicious head-cold/throat-infection combo recently. I don't have a tyrannical boss, there was just something that needed doing before a strict deadline and I was the only person able to do it. This resulted in me sitting in a communal office, constantly shivering, sweating copiously and making raspy noises. Passers-by were wondering why they'd employed a large amphibian in a shirt and why hadn't anyone returned the clearly distressed creature to a lake.

I know many who have done the same, gone to work despite an obvious and communicable illness, to avoid looking bad to their employers, who encourage this. How many other employees contract their illness due to this and how much this costs in lost productivity is impossible to say, but as long as nobody can directly be blamed for it, then that's fine (apparently).

But if you have to carry on despite illness, at least you can have a good moan about it. Unless, like me, you interact online with many people with debilitating, chronic conditions who constantly have to deal with their consequences as well as the associated stigmas. It's great that there are many channels now that give voice to those who suffer from physical or mental disabilities. On the down side, it does deter me from publicly sounding off about my sore throat. There's the thing about "checking your privilege" nowadays. Is health privilege a thing? I imagine so.

As a man, publicly mentioning being ill means you also run the risk of being diagnosed with "man flu". Man flu, for those who are unaware, is a virulent strain of flu that only infects men. The stronger immune system of men means that they survive infection by this powerful pathogen. If a woman caught man flu, she'd be killed in seconds, so the virus avoids them; a pathogen that immediately kills the host is an evolutionary dead-end. This has led to many women denying that man flu even exists, which is a fair point as it doesn't, but that's not really an excuse to mock someone who is genuinely ill.

Another issue with being a man with a summer cold is that you end up with a lot of used tissues scattered around. As it's less common to have a cold in summer, any visitors you have will jump to "less flattering" conclusions as to the origins of these.

On the up side, if you're a man who wants to engage in constant masturbation but can't be bothered to dispose of the evidence, a head cold provides the perfect alibi for excessive tissue use. Granted, someone could perform forensic tissue analysis (in every sense of the word) and find that your discarded "material" is made up of more gametes than expected. However, if you've gone through someone else's used tissues to see what's in them, it's hard to confront them with this information while retaining a position as the more dignified party.

No, YOU'VE thought about this too much!

As long as chronically ill people don't get the support they need, the economy remains feeble and the health service is strained beyond all reason, the best course of action when suffering from a temporary illness will remain confusing.

There may be a possible solution, though. I recall a barber I went to who told me his local GP was an Auschwitz survivor. People would often see him intending to get treatment for a minor ailment, at which point he would relay some anecdote about his treatment at the hands of the Nazis. Invariably the patient would "feel better" and leave.

Perhaps a system along these lines could be implemented. Maybe the chronically ill could be employed as waiting-room detectives, analogous to store detectives. The job would essentially be to sit in waiting rooms and stare at anyone there. When faced with a clearly sick or infirm person staring directly at them, it could potentially deter anyone who isn't really that ill, thus freeing up GP's time for genuine cases and easing their workload, reducing the risk of antibiotic resistance and easing pressure on the NHS, as well as providing gainful employment for people who struggle to find it elsewhere, boosting the economy in turn.

And thus, all problems are solved in one fell swoop, with the only concern being that it's probably impractical and quite unethical in many ways.

Sorry if this makes no sense. I've been ill.

Dean Burnett prefers to communicate via Twitter, to avoid passing his latest malady onto innocent strangers. @garwboy

• Infectious diseases
• Health
• Health & wellbeing
• Biology
• Human biology
• NHS
• Immunology

Dean Burnett
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A feedback app at Birmingham children's hospital allows patients to send comments directly to the manager in charge

At Birmingham children's hospital our children, young people and families are at the heart of everything we do and we're committed to making sure they have the best possible experience when they are with us.

We're always looking for innovative new ways to improve what we do but know we can't do this without really listening to what they think about our services and taking action to make it better.

In a paediatric environment it's just as important to hear about the experiences of our younger children and teens as it is to hear from parents and carers. This is why in addition to our most important resource, face-to-face communication, we offer a number of ways to feed back, such as feedback cards, ward surveys, texts and emails, but we find that the traditional methods can be slow and stop us from being able to respond as quickly as we would like.

The way that people communicate has changed so much in recent years and almost everyone who comes to our hospital has a smartphone. This is why we were keen to see how mobile technology could be used to gather feedback in a way that suits young people, families and staff.

We worked with Digital Life Sciences, staff, children and young people to come up with a feedback app that is fit for purpose and easy to use. We knew it needed to be anonymous to encourage honest and frank feedback and that a lengthy registration process would put people off. So we created a system where users fill in a text box and then click to send their comment directly to the manager in charge of the ward or area they have visited – in real-time.

They may be waiting in outpatients, sending the third or fourth comment of their inpatient stay, or they might be at home after being discharged – the app provides the flexibility to give feedback at any time.

It is also important for us to be open and transparent so that other people can benefit from the feedback. All the messages and responses are published live on our website, with strict processes in place to remove bad language and protect patient and staff confidentiality.

But without buy-in from our staff, we wouldn't have been able to make it work. Our nursing teams were involved in the development process and made sure it worked for them and our patients and families too.

Despite a few initial concerns about the technology and how it would fit into their daily routines, staff really see the benefit and find it rewarding to see the messages and be able to respond straight away. It helps validate the important role they play in the hospital and their impact on patients and families.

Our young people and families love it too because there are no cards to fill in and post and they can give their thoughts at a time that suits them, quickly and instantly – and they get a response back.

We've had around 500 messages since our pilot began and we're really excited about the app's future. We've have had lots of interest already from other trusts and I'm really pleased that our hard work will help improve patient experience elsewhere too.

Michelle McLoughlin is chief nurse at Birmingham children's hospital

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers. The Guardian has launched its Healthcare Innovation Awards to celebrate and share best practice across different areas of the healthcare sector. We want to showcase ideas or services that significantly improve the quality or management of care for patients. Entries for this year's awards close at midnight on Friday 28 June.

• Innovation
• Informatics
• Hospitals and acute care
• Efficiency
• Digital engagement
• NHS
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Burton Hospitals NHS Foundation Trust plans to go live with Meditech v6.0 this financial year.

More than 100 GP practices are using an app to detect the early signs of dementia in older patients.

University Hospitals of Morecambe Bay NHS Foundation Trust has asked the government to synchronise the contracts for all Lorenzo sites in the North, Midlands and East.

News, comment, blogposts and tweets across the sector

Clare HortonClaire BurkeSarah Johnson

The Care Quality Commission has launched a public consultation on proposals to change its inspection regime and introduce 'Ofsted-style' ratings for trusts and hospitals.

The Royal College of Nursing has welcomed the publication of the first draft of the National Review of Urgent and Emergency Care by NHS England.

Central Eastern Commissioning Support Unit is using a Harris portal to allow GPs to see information about children deemed 'at risk' by community colleagues.

North Bristol NHS Trust is replacing paper observation charts on patient beds with tablet computers in a pilot starting next month.

Surrey and Sussex Healthcare NHS Trust is implementing a patient experience system to collect feedback on its services.

'Tough and rigorous' ratings aim to drive up standards and give patients and families better insight into quality of treatment

Hospitals will be told to make urgent improvements if any department is providing poor care, under new Ofsted-style ratings prompted by the Mid Staffordshire NHS scandal.

The "tough and rigorous" ratings will go further than Ofsted's single overall ranking for schools in England by giving an official assessment, from "inadequate to "outstanding", based on inspections of every department of every hospital.

The Care Quality Commission (CQC), which regulates NHS care, hopes the ratings will drive up standards and give patients and families a better insight into the quality of treatment they can expect from particular hospital services.

Under CQC plans being unveiled on Monday, inspectors will rate every department, as well as each hospital and hospital trust, as inadequate, requires improvement, good or outstanding. The changes will begin in October, with the first ratings published in December.

The switch from the CQC's widely discredited hospital monitoring system was ordered by the health secretary, Jeremy Hunt, in the wake of Robert Francis QC's report in February into events at Stafford hospital, where between 400 and 1,200 patients died unnecessarily as a result of poor care and neglect from 2005-2008.

Inspectors will examine if the care is safe, effective, caring and compassionate, well-led and responsive to patients' needs, and decide on a rating for each. They will examine if staff have breached any of 10 new "fundamental standards" of care, as suggested by Francis.

Failings such as dementia patients being isolated in their rooms all day and not receiving support and stimulation, would be classed as a breach of the fundamental standards. Lapses such as a patient going thirsty because his or her water jug has not been filled, or hungry because staff have not helped with eating, would not necessarily on their own count as a breach, unless they were found to happen regularly or across a number of departments.

"It's going to be tougher and much more rigorous, and will be much more clear about when services are failing or inadequate," said David Behan, the watchdog's chief executive. Revelations about abusive treatment of patients at the Winterbourne View hospital for people with learning disabilities had also influenced the ratings, he said.

If an inspection reveals problems, the newly appointed chief inspector of hospitals, Professor Sir Mike Richards, will issue a warning notice, giving the hospital a fixed period in which to improve things, possibly just a few days.

Hunt welcomed the plans, as did the Academy of Medical Royal Colleges, which represents the UK's 220,000 doctors. Major changes needed in the NHS included "setting clear standards of care and publishing ratings so that patients have a single version of the truth about how their hospitals are performing on finance, leadership and, most importantly, the quality of care", said Hunt.

But NHS bosses voiced discontent. Mike Farrar, chief executive of the NHS Confederation, said: "We welcome steps to improve transparency within the NHS, but in doing so, we must avoid creating perverse incentives whereby a single focus develops on those areas being measured alone, at the expense of other areas [of care] that are equally as important."

The CQC had not yet persuaded NHS managers to accept the ratings, which risked "skewing resources to only those areas being measured", added Farrar. In a recent poll, 73% of NHS chief executives and chairs disagreed with Ofsted-style ratings.

• Hospitals
• Health policy
• Doctors
• Health
• Public services policy
• Jeremy Hunt
• NHS

Denis Campbell
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Shortage of midwives and beds resulting in women being forced to travel up to 65 miles to other wards or to give birth at home

Maternity wards are shutting their doors to expectant mothers more than 1,000 times a year, figures suggest.

Thousands of women have been forced to travel up to 65 miles to find an alternative ward or give birth at home due to staff shortages and a lack of beds, according to information obtained under the Freedom of Information act.

Data obtained by the Sunday Telegraph shows that 66 NHS trusts closed their doors at least 1,795 times in 2011 and 2012, while 40 did not close at all. With some returning figures for only part of that period and 34 not responding, the paper says that the actual number of closures is likely to be at least 2,370 during the past two years. Trusts reported 1,309 women being directed to other units, which the Telegraph says equates to 1,728 across the country, although, with many not keeping records, it estimates the true tally is likely to be substantially higher.

In January, the Royal College of Midwives warned that maternity services across the UK were at a "tipping point" because the NHS has 5,000 fewer midwives than it needs to cope with the rising number of births. Women in England had 688,120 babies in 2011 – the most in 40 years.

The Telegraph said in most cases a lack of beds or "capacity" was cited as the reason for closures, which typically lasted several hours at a time and sometimes saw wards shut for several days.

At Leeds teaching hospitals NHS trust, units closed 353 times in 24 months at two hospitals, although the trust said it ran an integrated service between its two maternity units and when one unit closed patients were sent to its other site, two miles away.

A spokesman said: "The number of times we have closed the whole service is low - just four times in the last two years.

"Since early this year we have started to triage all women before they arrive at the hospital through our maternity assessment centre. "When they report possible labour, we advise which delivery suite is currently taking admissions so that we match availability of beds and midwives to the needs of the women coming into hospital, ensuring the best support for them."

An NHS spokesman said women were directed to another unit when one was approaching capacity in the interests of patient safety.

He said: "This might only be for a short period of time to safely respond to peaks in demand. It is a carefully managed process which is in place in the best interests of mum and baby.

"During pregnancy, a woman will have detailed discussions with their midwife who will explain about the various birthing options available and scenarios like this where it might be more appropriate to go to another unit."

The spokesman said there had been a long history of a shortage of midwives but the NHS has 800 more midwives than in 2010 and a record 5,000 midwives are in training who will qualify over the next three years.

• NHS
• Pregnancy
• Health & wellbeing
• Family
• Parents and parenting
• Health
• Health policy
• Public services policy
• Hospitals

Haroon Siddique
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Health watchdog sets out proposals to restore public confidence in the NHS

Hospitals will regularly undergo tough two-week-long inspections and be given Ofsted-style ratings to revolutionise standards of care for patients, under coalition plans.

The government's health watchdog will set out how the current regime will be overhauled in the wake of a series of scandals that have damaged public confidence in the NHS. It is understood that the new system will be designed to provide patients with an easily understood barometer of the standards of care in their local hospitals.

Hospitals judged to be risking patients' health will be put into special measures – where experts force managers to change their habits, as happens now with failing schools.

The health secretary, Jeremy Hunt, believes the current system – under which trusts and care homes are merely told whether or not they meet certain minimum standards – encourages a "tick-box mentality" that leads to poor care.

The Care Quality Commission (CQC) will set out this week:

■ A new ratings scheme modelled on Ofsted schools ratings, with hospitals judged inadequate, requiring improvement, good, or outstanding.

■ A new failure regime that will see poor hospitals given a set period in which to improve before they are put into special measures.

■ A promise to patients about fundamental standards they should expect to receive when they enter a hospital.

A source said the CQC will consult on all details, but has been tasked by Hunt to move away from the current system in which hospitals are only judged on compliance with standards. Under the inspection plans, expert teams will use professional judgment, supported by objective measures and clinical evidence, to assess services.

It is understood the inspections of hospitals will vary in terms of what will be examined and will take as long as is needed, typically 15 days, with an average of six to seven days on site. In the vast majority of cases, inspections will be longer and more thorough than the CQC's current approach of a small team of inspectors on-site for one or two days.

A new failure regime will set out the three phases of action the CQC will engage in to identify and tackle serious problems with poor care in NHS trusts and NHS foundation trusts. These may be triggered by a specific incident but can also follow low ratings.

If the chief inspector of hospitals believes a trust requires significant improvement, the trust's board will be issued with a warning notice that requires the trust to improve within a fixed time period.

If the board is unable to resolve the problems, the chief inspector will formally request the healthcare regulator or the NHS Trust Development Authority to put the institution into special measures to protect people, to deal with the failure, and to hold individuals to account.

If care still fails to improve, the chief inspector will ensure a special administrator is appointed, suspending the board of the trust.

The move is in response to a major breakdown in public confidence in the NHS following the revelation that 1,200 patients needlessly died at Mid Staffs trust between 2005 and 2009. Hundreds of those cases are being investigated by police, who say there may be evidence of criminal neglect by staff.

A public inquiry led by Robert Francis QC reported in February that patients had been subjected to appalling suffering at the hospital, with failures at every level.

Since then, police and prosecutors, along with NHS regulators from the CQC, General Medical Council and Nursing and Midwifery Council, have been examining all 4,253 deaths at Stafford Hospital between 2005 and 2009.

Detectives are examining reports on care at the hospital, talking to the families of patients' families and scrutinising complaints, coroners' records and civil claims.

In its response to the Francis inquiry, the government will now also draw up a new set of fundamental standards of care for every hospital in the country.

It is Hunt's intention that the CQC will be able to prosecute breaches in these standards quickly and efficiently.

A consultation on the details of those standards will also be announced this week.

• Hospitals
• NHS
• Health
• Jeremy Hunt

Daniel Boffey
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Doctors say they are forced to see around 60 patients during 11-hour days even as hospital admittances rise

Many GPs are so inundated with demands for appointments that they can no longer guarantee to treat patients safely, according to a survey which found that overworked family doctors were feeling increasingly stressed.

Many GPs report that they are having to work 11-hour days and see up to 60 patients in that time in an attempt to cope with the extra demand created by longer surgery opening hours and growing numbers of very sick patients.

At the same time, the number of people turning up at hospital accident and emergency units has hit a record high, according to new NHS data that has led to renewed calls for the health service to do more to keep the sick from having to go to hospital.

A self-selecting survey of 258 family doctors across the UK, conducted for the Royal College of GPs, found 85% of them believed general practice was "in crisis" because of the sheer weight of patients, while half believed that they were so relentlessly busy that they could no longer be sure of providing safe patient care.

Some 55% of the GPs said they undertook 40-60 consultations a day. Until recently, they would only have seen that many in the event of a major health problem such as a flu outbreak. Six out of seven (84%) said their workload had increased substantially and 58% worked until at least 7pm. More than nine out of 10 (93%) said working in general practice had become more stressful in the past five years, while 22% had sought support or advice for work-related stress.

Almost half (48%) of the GPs believed patients were having to wait longer for consultations as a result of growing pressures. In 1995 patients visited their GP an average of 3.9 times a year; that has risen to 5.5 times.

"General practice is at the heart of the NHS and if it starts to buckle, the whole of the health service starts to buckle and patient care in both primary and secondary care will suffer," said Dr Clare Gerada, chair of the royal college. Urgent action, including agreement to increase general practice's share of the NHS budget from 9% to 10% so that 10,000 more GPs could be hired, was needed to make GPs' workloads sustainable, she added.

The British Medical Association said GPs were facing "intense pressure on a daily basis".

The Department of Health agreed that more GPs were needed. It has asked Health Education England to try to get 50% of medical students to become GPs.

Meanwhile, the number of patients going to A&E units is soaring, driven by a big rise in the number of older people needing care, NHS statistics have revealed. Total attendances at hospital A&E units in England have climbed every year for the past eight years, from 17.8m in 2004-05 to 21.7m in the first 11 months of 2012-13, a rise of 21.9%. However, attendances during March 2013 are likely to add another 2m to the 2012-13 total, pushing up the tally for the year to around 24m.

Figures released by the NHS's health and social care information centre depict a relentless rise in A&E attendances, but with a notably large jump occurring between 2011-12 (21.4m) and 2012-13 (21.7m after 11 months). These figures cast doubt on health secretary Jeremy Hunt's claim that the rise in A&E attendances was due to Labour's "historic mistake" in 2004 to let GPs no longer take responsibility for providing out-of-hours care.

• GPs
• Health
• NHS
• Doctors

Denis Campbell
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Clare HortonSarah JohnsonClaire Burke

The Royal college of Nursing has called for the Government to prioritise minimum unit pricing.

Rise in older people needing care has contributed to increase in hospital emergency visits to around 24 million a year

The number of patients going to accident and emergency departments has hit an all-time high, driven by a big rise in the number of older people needing care, NHS statistics have revealed.

Total attendances at hospital A&E units in England have climbed every year for the past eight years, from 17.837m in 2004-05 to 21.739m in the first 11 months of 2012-13 – a rise of 21.9%. However, attendances during March 2013 are likely to add another 2 million to the 2012-13 total, pushing the total attendances last year to around 24m.

Figures released by the NHS's Health and Social Care Information Centre (HSCIC) depict a relentless rise in A&E attendances, but with a notably large jump occurring between 2011-12 (21.481m) and 2012-13 (21.739m after 11 months). The figures cast serious doubt on health secretary Jeremy Hunt's recent claims that the rise in A&E attendances was due to Labour's "historic mistake" in 2004 of letting GPs no longer be responsible for providing out-of-hours care.

The ageing population, and the fact that growing numbers of older people are suffering from one or more long-term illnesses, such as diabetes and breathing problems, are key factors in the ongoing surge.

HSCIC data for the past five years shows that the number of people aged 60-79 attending A&E has risen from 1.729m in 2007-08 to 2.505m in the first 11 months of 2012-13, with a similarly steep increase among those aged at least 80 from 913,785 in 2007-08 to 1.408m in most of 2012-13.

The growing crisis in A&E has made headlines in recent months as medical organisations have voiced concern about what they say is an unsustainable rise in attendances and admissions. The College of Emergency Medicine (CEM), which represents A&E doctors, claims emergency departments are now under such pressure that they have become "like warzones".

The Department of Health responded to the new data by acknowledging the increasing pressures on A&E departments.

"There have been more than 1 million extra people visiting A&E over the last three years. Patients should expect a high-quality and timely service, and since the end of April over 95% of patients have been seen within four hours, as they were before last winter," a spokesman said.

"We know that emergency care services need to change to ensure people have access to the best care when they need it. That is why we have already asked NHS medical director Professor Sir Bruce Keogh to lead a review of urgent and emergency care looking at the demand and how the NHS can respond.

"We are looking at how we improve the health service to address the needs of older people, as over-70s account for 35% of emergency admissions. If the health service was better geared towards prevention for this age group we could reduce the pressure on A&E departments," he said.

The CEM has said that many A&E units are understaffed, with a particular shortage of consultants. But the HSCIC's figures also show that the number of doctors working in emergency departments in England increased by 71% over the past decade, from 3,183 in 2002 to 5,437 in 2012.

• Hospitals
• GPs
• Health
• Doctors
• NHS
• Emergency services
• Older people

Denis Campbell
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