Tag Archives: Manage

Seven ways … to manage irritable bowel syndrome

Irritable bowel syndrome may be inherited. It is linked to oversensitive nerves in the gut, causing debilitating pains and cramps among other symptoms. But there are ways to manage it and reduce its impact on your life.

Consider medication

Speak to your doctor about what is recommended for your particular type of IBS. If you have IBS with constipation (IBS-C), then laxatives could help. These range from osmotic laxatives, which increase water inside the colon, to cathartic laxatives, which stimulate the colon walls, although the latter may not be effective long-term. If you have IBS with diarrhoea (IBS-D), then over-the-counter medications such as loperamide can help control your symptoms.

Try probiotics

Research has suggested that changes in gut flora may trigger IBS by increasing inflammation and altering digestive motility. For some people, probiotics – available in capsules, powders and yoghurts – can alleviate symptoms, balancing gut flora by inhibiting the growth of disease-causing bacteria, slowing down bowel movements and fighting inflammation.

Move to a high-fibre diet

If you have IBS-C or IBS-D, then increasing dietary fibre with fruit, vegetables, beans, whole-grain breads and cereals may relieve symptoms. High-fat meals can cause problems by inducing vigorous colon contractions more rapidly than usual, which can trigger cramping and diarrhoea. However, IBS has quite a wide spectrum and only one in six IBS patients experience improvements from this diet. Others find that it worsens symptoms, and may benefit from a different regime such as a ketogenic (low carb) diet, aimed at reducing inflammation.

Take exercise

Research has suggested that 30 minutes of exercise, such as walking at a moderate pace, five days a week can significantly help to ease common symptoms such as constipation and abdominal cramps. It is best to consult your doctor about what exercise regime may be suitable, but try to keep a routine so you exercise at the same time each day and avoid exercising within an hour of meals.

Reduce your stress levels

Stress is widely thought to trigger IBS, partly because of the neural connections between the brain and the gut, and any external stressors make the mind more aware of painful colon spasms. IBS may be an auto-immune disorder, and the immune system is heavily affected by stress. Try to make time in your day for relaxation sessions and, if you have a stressful life, consider taking up yoga or meditation, or practise breathing exercises.

Keep a food diary

IBS patients have different triggers, so keep a daily diary of all the foods and drinks that make your symptoms flare up. If you experience bloating, you may want to try eliminating gas-producing foods such as resistant starch (found in cold potatoes and bread), beans, cruciferous vegetables such as cabbage, and carbonated drinks. Fructose, found in sweet vegetables and fruit, can also trigger diarrhoea, gas and bloating in IBS sufferers, and it is worth remembering that one in 10 IBS sufferers are lactose intolerant, so minimising dairy products can provide relief. Caffeine can make diarrhoea worse, so limit coffee and tea to three cups a day.

Try peppermint oil

Studies have shown that peppermint oil may be effective in reducing the severity of abdominal cramps and spasms, bloating and the intensity of bowel movement urgency and pain when passing stools, particularly in patients with IBS-D. Try purchasing enteric-coated peppermint oil, specially coated tablets that slowly release the oil in the small intestine.

Seven ways … to manage irritable bowel syndrome

Irritable bowel syndrome may be inherited. It is linked to oversensitive nerves in the gut, causing debilitating pains and cramps among other symptoms. But there are ways to manage it and reduce its impact on your life.

Consider medication

Speak to your doctor about what is recommended for your particular type of IBS. If you have IBS with constipation (IBS-C), then laxatives could help. These range from osmotic laxatives, which increase water inside the colon, to cathartic laxatives, which stimulate the colon walls, although the latter may not be effective long-term. If you have IBS with diarrhoea (IBS-D), then over-the-counter medications such as loperamide can help control your symptoms.

Try probiotics

Research has suggested that changes in gut flora may trigger IBS by increasing inflammation and altering digestive motility. For some people, probiotics – available in capsules, powders and yoghurts – can alleviate symptoms, balancing gut flora by inhibiting the growth of disease-causing bacteria, slowing down bowel movements and fighting inflammation.

Move to a high-fibre diet

If you have IBS-C or IBS-D, then increasing dietary fibre with fruit, vegetables, beans, whole-grain breads and cereals may relieve symptoms. High-fat meals can cause problems by inducing vigorous colon contractions more rapidly than usual, which can trigger cramping and diarrhoea. However, IBS has quite a wide spectrum and only one in six IBS patients experience improvements from this diet. Others find that it worsens symptoms, and may benefit from a different regime such as a ketogenic (low carb) diet, aimed at reducing inflammation.

Take exercise

Research has suggested that 30 minutes of exercise, such as walking at a moderate pace, five days a week can significantly help to ease common symptoms such as constipation and abdominal cramps. It is best to consult your doctor about what exercise regime may be suitable, but try to keep a routine so you exercise at the same time each day and avoid exercising within an hour of meals.

Reduce your stress levels

Stress is widely thought to trigger IBS, partly because of the neural connections between the brain and the gut, and any external stressors make the mind more aware of painful colon spasms. IBS may be an auto-immune disorder, and the immune system is heavily affected by stress. Try to make time in your day for relaxation sessions and, if you have a stressful life, consider taking up yoga or meditation, or practise breathing exercises.

Keep a food diary

IBS patients have different triggers, so keep a daily diary of all the foods and drinks that make your symptoms flare up. If you experience bloating, you may want to try eliminating gas-producing foods such as resistant starch (found in cold potatoes and bread), beans, cruciferous vegetables such as cabbage, and carbonated drinks. Fructose, found in sweet vegetables and fruit, can also trigger diarrhoea, gas and bloating in IBS sufferers, and it is worth remembering that one in 10 IBS sufferers are lactose intolerant, so minimising dairy products can provide relief. Caffeine can make diarrhoea worse, so limit coffee and tea to three cups a day.

Try peppermint oil

Studies have shown that peppermint oil may be effective in reducing the severity of abdominal cramps and spasms, bloating and the intensity of bowel movement urgency and pain when passing stools, particularly in patients with IBS-D. Try purchasing enteric-coated peppermint oil, specially coated tablets that slowly release the oil in the small intestine.

Seven ways … to manage irritable bowel syndrome

Irritable bowel syndrome may be inherited. It is linked to oversensitive nerves in the gut, causing debilitating pains and cramps among other symptoms. But there are ways to manage it and reduce its impact on your life.

Consider medication

Speak to your doctor about what is recommended for your particular type of IBS. If you have IBS with constipation (IBS-C), then laxatives could help. These range from osmotic laxatives, which increase water inside the colon, to cathartic laxatives, which stimulate the colon walls, although the latter may not be effective long-term. If you have IBS with diarrhoea (IBS-D), then over-the-counter medications such as loperamide can help control your symptoms.

Try probiotics

Research has suggested that changes in gut flora may trigger IBS by increasing inflammation and altering digestive motility. For some people, probiotics – available in capsules, powders and yoghurts – can alleviate symptoms, balancing gut flora by inhibiting the growth of disease-causing bacteria, slowing down bowel movements and fighting inflammation.

Move to a high-fibre diet

If you have IBS-C or IBS-D, then increasing dietary fibre with fruit, vegetables, beans, whole-grain breads and cereals may relieve symptoms. High-fat meals can cause problems by inducing vigorous colon contractions more rapidly than usual, which can trigger cramping and diarrhoea. However, IBS has quite a wide spectrum and only one in six IBS patients experience improvements from this diet. Others find that it worsens symptoms, and may benefit from a different regime such as a ketogenic (low carb) diet, aimed at reducing inflammation.

Take exercise

Research has suggested that 30 minutes of exercise, such as walking at a moderate pace, five days a week can significantly help to ease common symptoms such as constipation and abdominal cramps. It is best to consult your doctor about what exercise regime may be suitable, but try to keep a routine so you exercise at the same time each day and avoid exercising within an hour of meals.

Reduce your stress levels

Stress is widely thought to trigger IBS, partly because of the neural connections between the brain and the gut, and any external stressors make the mind more aware of painful colon spasms. IBS may be an auto-immune disorder, and the immune system is heavily affected by stress. Try to make time in your day for relaxation sessions and, if you have a stressful life, consider taking up yoga or meditation, or practise breathing exercises.

Keep a food diary

IBS patients have different triggers, so keep a daily diary of all the foods and drinks that make your symptoms flare up. If you experience bloating, you may want to try eliminating gas-producing foods such as resistant starch (found in cold potatoes and bread), beans, cruciferous vegetables such as cabbage, and carbonated drinks. Fructose, found in sweet vegetables and fruit, can also trigger diarrhoea, gas and bloating in IBS sufferers, and it is worth remembering that one in 10 IBS sufferers are lactose intolerant, so minimising dairy products can provide relief. Caffeine can make diarrhoea worse, so limit coffee and tea to three cups a day.

Try peppermint oil

Studies have shown that peppermint oil may be effective in reducing the severity of abdominal cramps and spasms, bloating and the intensity of bowel movement urgency and pain when passing stools, particularly in patients with IBS-D. Try purchasing enteric-coated peppermint oil, specially coated tablets that slowly release the oil in the small intestine.

Seven ways … to manage irritable bowel syndrome

Irritable bowel syndrome may be inherited. It is linked to oversensitive nerves in the gut, causing debilitating pains and cramps among other symptoms. But there are ways to manage it and reduce its impact on your life.

Consider medication

Speak to your doctor about what is recommended for your particular type of IBS. If you have IBS with constipation (IBS-C), then laxatives could help. These range from osmotic laxatives, which increase water inside the colon, to cathartic laxatives, which stimulate the colon walls, although the latter may not be effective long-term. If you have IBS with diarrhoea (IBS-D), then over-the-counter medications such as loperamide can help control your symptoms.

Try probiotics

Research has suggested that changes in gut flora may trigger IBS by increasing inflammation and altering digestive motility. For some people, probiotics – available in capsules, powders and yoghurts – can alleviate symptoms, balancing gut flora by inhibiting the growth of disease-causing bacteria, slowing down bowel movements and fighting inflammation.

Move to a high-fibre diet

If you have IBS-C or IBS-D, then increasing dietary fibre with fruit, vegetables, beans, whole-grain breads and cereals may relieve symptoms. High-fat meals can cause problems by inducing vigorous colon contractions more rapidly than usual, which can trigger cramping and diarrhoea. However, IBS has quite a wide spectrum and only one in six IBS patients experience improvements from this diet. Others find that it worsens symptoms, and may benefit from a different regime such as a ketogenic (low carb) diet, aimed at reducing inflammation.

Take exercise

Research has suggested that 30 minutes of exercise, such as walking at a moderate pace, five days a week can significantly help to ease common symptoms such as constipation and abdominal cramps. It is best to consult your doctor about what exercise regime may be suitable, but try to keep a routine so you exercise at the same time each day and avoid exercising within an hour of meals.

Reduce your stress levels

Stress is widely thought to trigger IBS, partly because of the neural connections between the brain and the gut, and any external stressors make the mind more aware of painful colon spasms. IBS may be an auto-immune disorder, and the immune system is heavily affected by stress. Try to make time in your day for relaxation sessions and, if you have a stressful life, consider taking up yoga or meditation, or practise breathing exercises.

Keep a food diary

IBS patients have different triggers, so keep a daily diary of all the foods and drinks that make your symptoms flare up. If you experience bloating, you may want to try eliminating gas-producing foods such as resistant starch (found in cold potatoes and bread), beans, cruciferous vegetables such as cabbage, and carbonated drinks. Fructose, found in sweet vegetables and fruit, can also trigger diarrhoea, gas and bloating in IBS sufferers, and it is worth remembering that one in 10 IBS sufferers are lactose intolerant, so minimising dairy products can provide relief. Caffeine can make diarrhoea worse, so limit coffee and tea to three cups a day.

Try peppermint oil

Studies have shown that peppermint oil may be effective in reducing the severity of abdominal cramps and spasms, bloating and the intensity of bowel movement urgency and pain when passing stools, particularly in patients with IBS-D. Try purchasing enteric-coated peppermint oil, specially coated tablets that slowly release the oil in the small intestine.

Seven ways … to prevent and manage RSI

Repetitive strain injury often starts gradually but can soon become severely debilitating. Bu there are ways to nip it in the bud – and alleviate the worst symptoms

Proper typing is key to preventing RSI.


Proper typing is key to preventing RSI. Photograph: Peter Dazeley/Getty Images

Don’t ignore it

Repetitive strain injury (RSI) causes pain, weakness, tingling and stiffness of the muscles, tendons, ligaments, nerves or other soft tissues and joints in the upper limbs from neck to fingers. It is also called upper limb disorder, cumulative trauma disorder or occupational overuse syndrome. It often starts gradually and is worse when you’re at work, but it can take on a life of its own and become constant and debilitating. Nip it in the bud by taking short, frequent breaks from repetitive tasks such as typing. Check the ergonomics of your work station and try not to slouch at your desk.

Use both hands

Proper typing is key to preventing RSI. Contorting the fingers of one hand to reach more than one key at once, especially if you’re typing one-handed while holding your phone against the other ear, is a recipe for muscle strain. It’s like playing the piano; correct fingering is essential. Basic typing skills aren’t often taught in schools; they should be.

Get up

Try to get up from your desk every 30 minutes and move your neck and shoulders to release tension. A 10-minute break every hour (a stroll to the loo or to make a drink) is advised. One good tip is to time how long you can type before getting symptoms (eg pins and needles or muscle ache) and then set an alarm to stop typing 10 minutes before that time.

Pray

Stretching can help to prevent and manage RSI. The prayer stretch involves putting the palms of your hands together, pointing up; push to one side then the other for 15-30 seconds at a time. If stretches make RSI worse, see a physiotherapist for expert advice.

It’s in the wrist action

To prevent RSI, keep wrists straight and flat when typing. Sit with thighs level, feet flat on floor (or on footrest), sit up straight, shoulders relaxed, upper arms at sides, not splayed out, forearms horizontal or tilted slightly downwards, so knees and elbows are at a right angle. Keep the top of your screen at eye level and adjust the position of your keyboard, so it’s easy to reach without stretching or hunching.

Assess your risk

Your employer should carry out a risk assessment when you join to check that your work area suits you. You can request an assessment if you haven’t had one or if you’re developing symptoms of RSI.

Treat yourself

There’s nothing better than prevention. But if you have symptoms of mild RSI, you can try short courses of anti-inflammatory painkillers (ibuprofen gel or tablets), hot and cold packs, elastic supports and splints. Some people are helped by yoga, massage and meditation. An expert opinion from an osteopath, physiotherapist, GP or occupational health doctor or nurse is important if symptoms persist and are severe. Referral to a joint specialist (rheumatologist) or pain clinic is a good idea in severe cases.

Hospitals attack ‘barking mad’ NHS target to manage winter crisis

Health service chiefs have been declared “barking mad” for ordering hospitals to ensure no patient is treated in a corridor or languishes on a trolley for hours when this year’s winter crisis hits.

NHS England’s instructions, intended to avoid a repeat of hospitals’ descent into the sort of meltdown seen last year, also say that patients should not have to wait more than 15 minutes in the back of an ambulance outside an A&E unit as they wait to be handed over to hospital staff.

Critics have described the plans, outlined in a four-page letter sent to hospital chiefs as “la-la land”, “totally unrealistic” and an attempt “to create Narnia”. Hospital bosses say they regularly have to use all the three tactics which the NHS wants to ban in order to help them cope with the influx of patients created by winter weather and seasonal infections.

“We all aspire to avoiding doing any of those things. But trying to flog a dead horse, or to create Narnia, through a new set of executive instructions isn’t going to help us,” said Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors.

“Our urgent and emergency care system is under extreme stress going into winter. Given that hospitals are underbedded and underfunded, and emergency departments are understaffed, trying to deliver performance in that climate is nigh-on impossible. We have to define reality rather than delude ourselves about the scale of this problem of caring safely for patients during winter.”

One NHS trust chief executive, who spoke on condition of anonymity, said: “They are barking mad. Patients are waiting on corridors already. This will only get worse as we progress through winter. Twelve-hour trolley breaches in some hospitals are no longer unusual, and for some no longer cause distress or outrage as they are viewed as inevitable. The demands are not realistic.”

Disclosure of NHS England’s attempt to impose a detailed series of duties on hospitals comes amid claims by senior insiders that its leadership is in a state of panic over winter.

Theresa May has told Simon Stevens, the organisation’s chief executive, that he is “personally responsible” for how the NHS performs during what most expect to be a very tough winter, with a flu outbreak feared. Some NHS bosses believe that the prime minister’s move is intended to protect Jeremy Hunt, the health secretary, who they blame for underfunding it and presiding over huge staffing problems.

The regulator NHS Improvement warned last week that the service was already under such pressure, with hospital wards too full after the failure of a £1bn exercise to free up 2,000-3,000 beds, that it was in an “extremely challenging” position.

NHS England’s plans are laid out in a letter sent to all 233 NHS trusts and 209 clinical commissioning groups on 7 June by Pauline Philip, its national director of urgent and emergency care, headed “Winter briefing one: operational management of winter – expectations and communication”. Philip sets out actions “to consistently ensure that safety is maintained during times of significant pressure”. They include an edict that “clinical escalation will need to ensure that patients are not cared for on hospital corridors; 12-hour trolley waits in the emergency department never happen; [and] patients do not wait more than 15 minutes in ambulances before being handed over to the hospital”.

But hospital bosses claim their struggle to keep up with the sheer demand for care over winter, while maintaining patient safety, forces them to deploy the three practices Philip wants to end. Another chief executive said: “This is totally la-la land thinking. The pressure is mounting now. I don’t think any of the areas ‘to be avoided’ will be. Many chairs and non-executive directors of trusts are in complete disbelief about NHS England’s tone and approach.” Serious doubts have been raised about the ability of hospitals to do what Philip has asked. For instance, 1,597 patients had to wait at least 12 hours in an A&E unit to be admitted into the hospital itself in January to March this year, when cold weather caused a spike in illness that led to the NHS experiencing its most pressurised winter ever. So many hospitals struggled so much last January that the British Red Cross called the situation “a humanitarian crisis”.

NHS England, working alongside NHS Improvement and Public Health England, have made unprecedented joint efforts to ensure the health service can withstand this winter’s rigours. For example, NHSE has put £237m into a campaign to offer free flu jabs to a record 21m people including expanded numbers of primary schoolchildren and, for the first time, care home staff.

Chris Hopson, chief executive of NHS Providers, which represents trusts, said hospitals would do everything they could to avoid trolley waits or patients being treated on corridors, and minimise patient handover times between ambulance and A&E staff. But he added: “The indications are that flu may cause more problems than we have seen in recent years. And a prolonged cold spell – often linked to falls and respiratory problems – could make matters worse. So we need to be realistic and honest.

“Trusts cannot guarantee that these problems will not happen. What they can do – and are doing – is to have strong and well developed plans in place to identify when they are struggling to cope, so they can call on support to ensure patients get the best care possible.”

Hospitals attack ‘barking mad’ NHS target to manage winter crisis

Health service chiefs have been declared “barking mad” for ordering hospitals to ensure no patient is treated in a corridor or languishes on a trolley for hours when this year’s winter crisis hits.

NHS England’s instructions, intended to avoid a repeat of hospitals’ descent into the sort of meltdown seen last year, also say that patients should not have to wait more than 15 minutes in the back of an ambulance outside an A&E unit as they wait to be handed over to hospital staff.

Critics have described the plans, outlined in a four-page letter sent to hospital chiefs as “la-la land”, “totally unrealistic” and an attempt “to create Narnia”. Hospital bosses say they regularly have to use all the three tactics which the NHS wants to ban in order to help them cope with the influx of patients created by winter weather and seasonal infections.

“We all aspire to avoiding doing any of those things. But trying to flog a dead horse, or to create Narnia, through a new set of executive instructions isn’t going to help us,” said Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors.

“Our urgent and emergency care system is under extreme stress going into winter. Given that hospitals are underbedded and underfunded, and emergency departments are understaffed, trying to deliver performance in that climate is nigh-on impossible. We have to define reality rather than delude ourselves about the scale of this problem of caring safely for patients during winter.”

One NHS trust chief executive, who spoke on condition of anonymity, said: “They are barking mad. Patients are waiting on corridors already. This will only get worse as we progress through winter. Twelve-hour trolley breaches in some hospitals are no longer unusual, and for some no longer cause distress or outrage as they are viewed as inevitable. The demands are not realistic.”

Disclosure of NHS England’s attempt to impose a detailed series of duties on hospitals comes amid claims by senior insiders that its leadership is in a state of panic over winter.

Theresa May has told Simon Stevens, the organisation’s chief executive, that he is “personally responsible” for how the NHS performs during what most expect to be a very tough winter, with a flu outbreak feared. Some NHS bosses believe that the prime minister’s move is intended to protect Jeremy Hunt, the health secretary, who they blame for underfunding it and presiding over huge staffing problems.

The regulator NHS Improvement warned last week that the service was already under such pressure, with hospital wards too full after the failure of a £1bn exercise to free up 2,000-3,000 beds, that it was in an “extremely challenging” position.

NHS England’s plans are laid out in a letter sent to all 233 NHS trusts and 209 clinical commissioning groups on 7 June by Pauline Philip, its national director of urgent and emergency care, headed “Winter briefing one: operational management of winter – expectations and communication”. Philip sets out actions “to consistently ensure that safety is maintained during times of significant pressure”. They include an edict that “clinical escalation will need to ensure that patients are not cared for on hospital corridors; 12-hour trolley waits in the emergency department never happen; [and] patients do not wait more than 15 minutes in ambulances before being handed over to the hospital”.

But hospital bosses claim their struggle to keep up with the sheer demand for care over winter, while maintaining patient safety, forces them to deploy the three practices Philip wants to end. Another chief executive said: “This is totally la-la land thinking. The pressure is mounting now. I don’t think any of the areas ‘to be avoided’ will be. Many chairs and non-executive directors of trusts are in complete disbelief about NHS England’s tone and approach.” Serious doubts have been raised about the ability of hospitals to do what Philip has asked. For instance, 1,597 patients had to wait at least 12 hours in an A&E unit to be admitted into the hospital itself in January to March this year, when cold weather caused a spike in illness that led to the NHS experiencing its most pressurised winter ever. So many hospitals struggled so much last January that the British Red Cross called the situation “a humanitarian crisis”.

NHS England, working alongside NHS Improvement and Public Health England, have made unprecedented joint efforts to ensure the health service can withstand this winter’s rigours. For example, NHSE has put £237m into a campaign to offer free flu jabs to a record 21m people including expanded numbers of primary schoolchildren and, for the first time, care home staff.

Chris Hopson, chief executive of NHS Providers, which represents trusts, said hospitals would do everything they could to avoid trolley waits or patients being treated on corridors, and minimise patient handover times between ambulance and A&E staff. But he added: “The indications are that flu may cause more problems than we have seen in recent years. And a prolonged cold spell – often linked to falls and respiratory problems – could make matters worse. So we need to be realistic and honest.

“Trusts cannot guarantee that these problems will not happen. What they can do – and are doing – is to have strong and well developed plans in place to identify when they are struggling to cope, so they can call on support to ensure patients get the best care possible.”

Hospitals attack ‘barking mad’ NHS target to manage winter crisis

Health service chiefs have been declared “barking mad” for ordering hospitals to ensure no patient is treated in a corridor or languishes on a trolley for hours when this year’s winter crisis hits.

NHS England’s instructions, intended to avoid a repeat of hospitals’ descent into the sort of meltdown seen last year, also say that patients should not have to wait more than 15 minutes in the back of an ambulance outside an A&E unit as they wait to be handed over to hospital staff.

Critics have described the plans, outlined in a four-page letter sent to hospital chiefs as “la-la land”, “totally unrealistic” and an attempt “to create Narnia”. Hospital bosses say they regularly have to use all the three tactics which the NHS wants to ban in order to help them cope with the influx of patients created by winter weather and seasonal infections.

“We all aspire to avoiding doing any of those things. But trying to flog a dead horse, or to create Narnia, through a new set of executive instructions isn’t going to help us,” said Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors.

“Our urgent and emergency care system is under extreme stress going into winter. Given that hospitals are underbedded and underfunded, and emergency departments are understaffed, trying to deliver performance in that climate is nigh-on impossible. We have to define reality rather than delude ourselves about the scale of this problem of caring safely for patients during winter.”

One NHS trust chief executive, who spoke on condition of anonymity, said: “They are barking mad. Patients are waiting on corridors already. This will only get worse as we progress through winter. Twelve-hour trolley breaches in some hospitals are no longer unusual, and for some no longer cause distress or outrage as they are viewed as inevitable. The demands are not realistic.”

Disclosure of NHS England’s attempt to impose a detailed series of duties on hospitals comes amid claims by senior insiders that its leadership is in a state of panic over winter.

Theresa May has told Simon Stevens, the organisation’s chief executive, that he is “personally responsible” for how the NHS performs during what most expect to be a very tough winter, with a flu outbreak feared. Some NHS bosses believe that the prime minister’s move is intended to protect Jeremy Hunt, the health secretary, who they blame for underfunding it and presiding over huge staffing problems.

The regulator NHS Improvement warned last week that the service was already under such pressure, with hospital wards too full after the failure of a £1bn exercise to free up 2,000-3,000 beds, that it was in an “extremely challenging” position.

NHS England’s plans are laid out in a letter sent to all 233 NHS trusts and 209 clinical commissioning groups on 7 June by Pauline Philip, its national director of urgent and emergency care, headed “Winter briefing one: operational management of winter – expectations and communication”. Philip sets out actions “to consistently ensure that safety is maintained during times of significant pressure”. They include an edict that “clinical escalation will need to ensure that patients are not cared for on hospital corridors; 12-hour trolley waits in the emergency department never happen; [and] patients do not wait more than 15 minutes in ambulances before being handed over to the hospital”.

But hospital bosses claim their struggle to keep up with the sheer demand for care over winter, while maintaining patient safety, forces them to deploy the three practices Philip wants to end. Another chief executive said: “This is totally la-la land thinking. The pressure is mounting now. I don’t think any of the areas ‘to be avoided’ will be. Many chairs and non-executive directors of trusts are in complete disbelief about NHS England’s tone and approach.” Serious doubts have been raised about the ability of hospitals to do what Philip has asked. For instance, 1,597 patients had to wait at least 12 hours in an A&E unit to be admitted into the hospital itself in January to March this year, when cold weather caused a spike in illness that led to the NHS experiencing its most pressurised winter ever. So many hospitals struggled so much last January that the British Red Cross called the situation “a humanitarian crisis”.

NHS England, working alongside NHS Improvement and Public Health England, have made unprecedented joint efforts to ensure the health service can withstand this winter’s rigours. For example, NHSE has put £237m into a campaign to offer free flu jabs to a record 21m people including expanded numbers of primary schoolchildren and, for the first time, care home staff.

Chris Hopson, chief executive of NHS Providers, which represents trusts, said hospitals would do everything they could to avoid trolley waits or patients being treated on corridors, and minimise patient handover times between ambulance and A&E staff. But he added: “The indications are that flu may cause more problems than we have seen in recent years. And a prolonged cold spell – often linked to falls and respiratory problems – could make matters worse. So we need to be realistic and honest.

“Trusts cannot guarantee that these problems will not happen. What they can do – and are doing – is to have strong and well developed plans in place to identify when they are struggling to cope, so they can call on support to ensure patients get the best care possible.”

How to manage mental health at work

In recent months, a number of high-profile figures have spoken frankly about their experiences of mental health. Prince Harry has disclosed the anxiety and panic attacks he experienced following the sudden death of his mother, while former England cricketer Freddie Flintoff and rapper Professor Green have also both opened up about their mental health.

Experts welcome such open discussions on mental health, which has been a taboo subject for far too long. “It’s great that more people feel able to talk about their mental health,” says Madeleine McGivern, head of workplace wellbeing programmes at the charity Mind. “There is still a long way to go – especially in many workplaces – but things are definitely moving in the right direction.”

Hilda Burke, a psychotherapist, life coach and couples’ counsellor at her practice Hilda Burke Psychotherapy, agrees. She says there has been more awareness generally. “Several clients have come my way after their managers have offered to fund some short-term therapy.”

This move to more open discussions on the subject comes as two-thirds of British adults have admitted to having experienced mental ill-health at some point in their lives, according to research published by the Mental Health Foundation. In the Queen’s speech last month, the government set out details on how it plans to improve mental health services but failed to provide any further information on the additional 10,000 extra staff for the sector, as outlined in its manifesto.

Don’t sweep it under the carpet

For those experiencing mental health issues, do try to approach your employer about your concerns. “You don’t have to be specific,” says Andy Silvester, head of campaigns and deputy director of policy at the Institute of Directors (IoD). “Say that you think you could benefit from some time off to seek advice from the many charities and providers that are out there. You’d be surprised how often employers are open to those conversations.”

If you are thinking of speaking to a colleague or manager for the first time about your mental health, think about how and when you do this, says McGivern. “Once you have this conversation, it can’t be ‘unsaid’, so it’s important you feel secure and safe in disclosing your mental health problem.”


There is still a long way to go, but things are definitely moving in the right direction

Madeleine McGivern

If you don’t speak out, you’re potentially denying yourself support, warns Burke. “I work with many clients for whom anxiety and panic attacks are something that they struggle with at work,” she says. “A key issue, I believe, facing these clients is shame around admitting to some of these conditions and so rather than having an open and frank discussion with their employers they invest a lot of energy in trying to hide their symptoms.”

Switch off after work

One of the biggest issues facing employees in relation to their mental wellbeing is the inability to switch off after work, with smartphones continually pinging with email notifications.

“How we manage the great flexibility and new opportunities that technology and digital advancement gives us is also really important to ensuring that we have some time to switch off from work, and maintain a good work-life balance – both of which are important in terms of wellbeing,” says McGivern.

Knowing when it’s getting too much is crucial. “Think about what keeps you well at work, and the signs you’ll recognise in yourself if you start to struggle,” says McGivern. “If you can, communicate this to your manager. Either way, make sure you keep a support network outside of work, and try to maintain a proper balance between work and life.”

As well as having an honest conversation with your manager about your mental health situation, also be truthful to yourself about your needs, says Gillian Connor, head of policy partnerships at the charity Rethink Mental Illness. “Whether that’s going out for a lunchtime walk, leaving on time, not taking work home with you.”

Burke agrees: “Having healthy boundaries in place at work, knowing when it’s getting too much and being able to create space for ourselves is crucial for good mental health.”

Making changes in the workplace

Workplaces need to become mental-health friendly, argues Connor. “This will help more people feel comfortable about disclosing when they have a health problem,” she says. “It’s also important that employers themselves understand their responsibilities under the law, as well as other steps they can take to get the best out of a diverse workforce. Outside the workplace, we need better access to services – such as talking therapies – as well as improved attitudes towards mental illness.”

Silvester also suggests publicising “a formal mental health policy which says something to the effect that nobody will be stigmatised”, such as putting up Time to Change [the mental health campaign run by Rethink Mental Illness] or Mind posters around the office.

Mental illness also impacts the self-employed

When some people think of mental illness at work, they immediately think of the office environment. But being ill at work isn’t confined to the office. As a self-employed person or freelancer, the demands of juggling your own company often with no clear work-life divide can be very stressful.

Silvester says the IoD’s research has found that there were plenty of self-employed people experiencing mental health issues. “Working for yourself isn’t a silver bullet to ensure good mental health,” he says.

Despite the challenges of working in an office, Craig Jackson, a professor of occupational health psychology and head of psychology at Birmingham City University, is keen to add that there are benefits to working life: “We should remember that work also provides many benefits for individuals – psychological, emotional, cognitive, social.”

Looking for a job? Browse Guardian Jobs or sign up to Guardian Careers for the latest job vacancies and career advice

How to manage mental health at work

In recent months, a number of high-profile figures have spoken frankly about their experiences of mental health. Prince Harry has disclosed the anxiety and panic attacks he experienced following the sudden death of his mother, while former England cricketer Freddie Flintoff and rapper Professor Green have also both opened up about their mental health.

Experts welcome such open discussions on mental health, which has been a taboo subject for far too long. “It’s great that more people feel able to talk about their mental health,” says Madeleine McGivern, head of workplace wellbeing programmes at the charity Mind. “There is still a long way to go – especially in many workplaces – but things are definitely moving in the right direction.”

Hilda Burke, a psychotherapist, life coach and couples’ counsellor at her practice Hilda Burke Psychotherapy, agrees. She says there has been more awareness generally. “Several clients have come my way after their managers have offered to fund some short-term therapy.”

This move to more open discussions on the subject comes as two-thirds of British adults have admitted to having experienced mental ill-health at some point in their lives, according to research published by the Mental Health Foundation. In the Queen’s speech last month, the government set out details on how it plans to improve mental health services but failed to provide any further information on the additional 10,000 extra staff for the sector, as outlined in its manifesto.

Don’t sweep it under the carpet

For those experiencing mental health issues, do try to approach your employer about your concerns. “You don’t have to be specific,” says Andy Silvester, head of campaigns and deputy director of policy at the Institute of Directors (IoD). “Say that you think you could benefit from some time off to seek advice from the many charities and providers that are out there. You’d be surprised how often employers are open to those conversations.”

If you are thinking of speaking to a colleague or manager for the first time about your mental health, think about how and when you do this, says McGivern. “Once you have this conversation, it can’t be ‘unsaid’, so it’s important you feel secure and safe in disclosing your mental health problem.”


There is still a long way to go, but things are definitely moving in the right direction

Madeleine McGivern

If you don’t speak out, you’re potentially denying yourself support, warns Burke. “I work with many clients for whom anxiety and panic attacks are something that they struggle with at work,” she says. “A key issue, I believe, facing these clients is shame around admitting to some of these conditions and so rather than having an open and frank discussion with their employers they invest a lot of energy in trying to hide their symptoms.”

Switch off after work

One of the biggest issues facing employees in relation to their mental wellbeing is the inability to switch off after work, with smartphones continually pinging with email notifications.

“How we manage the great flexibility and new opportunities that technology and digital advancement gives us is also really important to ensuring that we have some time to switch off from work, and maintain a good work-life balance – both of which are important in terms of wellbeing,” says McGivern.

Knowing when it’s getting too much is crucial. “Think about what keeps you well at work, and the signs you’ll recognise in yourself if you start to struggle,” says McGivern. “If you can, communicate this to your manager. Either way, make sure you keep a support network outside of work, and try to maintain a proper balance between work and life.”

As well as having an honest conversation with your manager about your mental health situation, also be truthful to yourself about your needs, says Gillian Connor, head of policy partnerships at the charity Rethink Mental Illness. “Whether that’s going out for a lunchtime walk, leaving on time, not taking work home with you.”

Burke agrees: “Having healthy boundaries in place at work, knowing when it’s getting too much and being able to create space for ourselves is crucial for good mental health.”

Making changes in the workplace

Workplaces need to become mental-health friendly, argues Connor. “This will help more people feel comfortable about disclosing when they have a health problem,” she says. “It’s also important that employers themselves understand their responsibilities under the law, as well as other steps they can take to get the best out of a diverse workforce. Outside the workplace, we need better access to services – such as talking therapies – as well as improved attitudes towards mental illness.”

Silvester also suggests publicising “a formal mental health policy which says something to the effect that nobody will be stigmatised”, such as putting up Time to Change [the mental health campaign run by Rethink Mental Illness] or Mind posters around the office.

Mental illness also impacts the self-employed

When some people think of mental illness at work, they immediately think of the office environment. But being ill at work isn’t confined to the office. As a self-employed person or freelancer, the demands of juggling your own company often with no clear work-life divide can be very stressful.

Silvester says the IoD’s research has found that there were plenty of self-employed people experiencing mental health issues. “Working for yourself isn’t a silver bullet to ensure good mental health,” he says.

Despite the challenges of working in an office, Craig Jackson, a professor of occupational health psychology and head of psychology at Birmingham City University, is keen to add that there are benefits to working life: “We should remember that work also provides many benefits for individuals – psychological, emotional, cognitive, social.”

Looking for a job? Browse Guardian Jobs or sign up to Guardian Careers for the latest job vacancies and career advice