Category: NHS

What is Seasonal Affective Disorder (SAD) and How is it Managed?

At this time of year, I am often asked by patients about Seasonal Affective Disorder (SAD). This is a is a type of low mood or depression that is related to changes in the seasons. It typically begins and ends at about the same times every year. Most people with SAD experience symptoms starting in the Autumn that continue into the winter months.

Symptoms of SAD may include:

– Feeling depressed most of the day, nearly every day
– Losing interest in activities you once enjoyed
– Low energy and fatigue
– Sleep disturbances (oversleeping or insomnia)
– Changes in appetite or weight (often craving for foods high in carbohydrates)
– Feeling sluggish or agitated
– Difficulty concentrating
– Feelings of hopelessness, worthlessness, or guilt

In more severe cases there can also be thoughts of self-harm, death or suicide.

The causes of SAD are not fully understood but are believed to be related to the reduction in sunlight in Autumn and Winter. This decrease in sunlight may disrupt the body’s internal clock and lead to feelings of depression.

Reduced sunlight can also cause a drop in serotonin, a brain chemical (neurotransmitter) that affects mood, and affect the balance of melatonin, which plays a role in sleep patterns and mood.

Patients also ask how can SAD be treated and the symptoms of SAD improved?

– Get regular exercise. Exercise can help to improve your mood and sleep. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.

– Eat a healthy diet. Eating healthy foods can help to boost your mood and energy levels. Aim to eat plenty of fruits, vegetables, and whole grains.

– Get enough sleep. Most adults need around 7-8 hours of sleep per night. However, people with SAD may need more sleep than this.

– Spend time outdoors. Even if it’s cold, try to get outside for at least 30 minutes each day. Getting some sunlight can help to improve your mood and sleep.

– Talk to a doctor or therapist. If you’re struggling to manage your symptoms, talk to your doctor, therapist or local mental health team. They can help you to develop a treatment plan that works for you.

– Self- Referral. Many parts of England allow you to refer yourself to local mental health services without requiring a referral from your doctor.

Should we shift from using ‘junior doctors’ to postgraduate doctors?

In the UK’s National Health Service (NHS), the language we use to describe medical professionals holds significant weight. The term ‘junior doctor,’ a longstanding descriptor for doctors in training or those in their early postgraduate years in the UK, is now being re-evaluated. The British Medical Association (BMA) has highlighted the need for a terminology update to more accurately reflect the expertise and responsibilities of these vital healthcare professionals. Our article in BJGP Open discusses this issue further.

The Need for Change

The term ‘junior doctor’ has been a staple in the UK medical lexicon for decades, but it fails to capture the breadth of experience and skill these doctors possess. These professionals, who may have up to a decade of training, are fully qualified and play a crucial role in patient care, performing a wide range of duties from diagnosis to complex medical procedures. The current term may inadvertently diminish their value and expertise.

A More Accurate Representation

As the roles of these doctors evolve with advancing medicine, so too should the terminology. The proposed shift to ‘postgraduate doctors’ better represents their level of education and training, impacting how they are perceived by patients, colleagues, and the broader public. This change is particularly pertinent in primary care, where these doctors often serve as critical members of the clinical team and are involved in supervisory roles.

Enhancing Recruitment and Job Satisfaction

This rebranding is more than a semantic shift; it’s a move that could influence recruitment into medical specialties, including general practice. At a time when the NHS faces challenges in recruiting for general practice roles, recognizing the perspectives and contributions of this younger generation of doctors is crucial.

Supporting Evidence

A report by Prof Scarlett McNally for Health Education England (HEE) found overwhelming support for moving away from the term ‘junior doctor.’ The majority of respondents, including doctors, patients, and healthcare staff, favoured ‘postgraduate doctors’ as a more appropriate alternative. This change also aligns with the desire for clarity regarding a doctor’s seniority level.

Implications for Patient Care

The term ‘junior doctor’ can inadvertently cause patient anxiety, especially in high-stress situations. Introducing oneself as a ‘doctor’ or ‘postgraduate doctor’ can instil more confidence in patients. Clear designations on name badges and specific introductions can reduce uncertainty and potential bias.

A Collective Effort

The support for this change isn’t limited to the BMA; various surgical and medical royal colleges in the UK have also advocated for moving away from the term ‘junior doctors.’ This collective effort underscores the importance of language in shaping patient perception and trust.

Conclusion

As healthcare evolves, so must our language. The shift from ‘junior doctors’ to ‘postgraduate doctors’ is more than a nominal change; it’s a step towards a more accurate, respectful, and empowering representation of these medical professionals. This change not only recognizes their expertise and contributions but also enhances patient care and trust in the healthcare system. The medical community should actively engage in discussions and work towards implementing this revised designation, reflecting the realities of modern medical practice.

Boosting Vaccine Uptake in Pregnancy: What Works and What Doesn’t

Pregnancy is a time of anticipation and preparation. But it’s also a time when expectant mothers must be vigilant about their health — not just for themselves but for their unborn children as well. Vaccinations against COVID-19, influenza, and pertussis are vital during this period, yet many pregnant women hesitate to get these lifesaving shots. Let’s delve into recent research that sheds light on effective strategies to increase vaccine uptake among pregnant women.

Our study published in the Journal of Travel Medicine reviewed studies from January 2012 to December 2022, following the gold-standard PRISMA guidelines, to identify interventions that successfully increase vaccine uptake in pregnant women. The meta-analysis focused on three key diseases: COVID-19, influenza, and pertussis — all of which pose significant risks to both mother and child.

Key Findings

Out of 2,681 articles, 39 studies were relevant, comprising over 168,000 participants from nine different countries. Interestingly, while 15 of these were randomized controlled trials, the quality of evidence was strong in only 18% of the studies. Here’s what we found:

– For influenza, interventions modestly increased vaccine uptake, but the overall effect was small.

– For pertussis, the data showed no clear benefit from the interventions.

– There were no randomized controlled trials available for COVID-19 vaccine interventions during pregnancy.

The ‘Three Ps’ Approach

The interventions that were examined fell into three categories — patient, provider, and policy-level strategies.

Patient-Level: The most effective strategies at this level involved healthcare professionals giving clear recommendations, supplemented by text reminders and written information. Personalized face-to-face discussions that addressed concerns, debunked myths, and emphasized benefits were particularly effective.

Provider-Level: Educating healthcare professionals about the vaccines’ safety and importance, along with reminders to offer them as part of routine care, made a significant difference.

Policy-Level: Financial incentives, mandatory recording of vaccination data, and ensuring vaccines are readily available were key policy interventions that showed promise.

Conclusions

Our study indicates that while there’s some success in increasing influenza vaccinations, the overall impact of interventions is modest. Pertussis vaccine interventions didn’t show a clear benefit, and data on COVID-19 interventions is lacking.

What’s clear is the pivotal role of healthcare providers in educating and encouraging pregnant women to get vaccinated. There’s also untapped potential in mobile health technologies that could further promote vaccination during pregnancy.

The takeaway message is that a concerted effort combining clear communication, education, and policy support is essential to protect both mothers and their babies from vaccine-preventable diseases. As the medical community continues to explore and implement these interventions, the hope is to see a significant rise in vaccine uptake, ensuring safer pregnancies and healthier babies.

The Next Steps

For healthcare providers, the message is to continue the dialogue with expectant mothers, ensuring they have all the information they need to make informed decisions about vaccinations. For policymakers, the challenge is to create an environment where vaccinations are not just available but are actively and consistently promoted as part of prenatal care. And for expectant mothers, our study underscores the importance of discussing vaccinations with healthcare providers to ensure the healthiest possible start for their children.

Closing Thoughts

Vaccinations during pregnancy aren’t just a personal choice; they’re a public health priority. Our study provides a roadmap for increasing vaccine uptake — a mission that, if successful, could mean the difference between life and death for the most vulnerable among us.

Chickenpox vaccination in the UK

The Joint Committee on Vaccination and Immunisation (JCVI) recommending the inclusion of the chickenpox (varicella) vaccine in the UK’s childhood immunisation schedule is a significant step for public health. This decision aligns the UK with many other countries that have already integrated the chickenpox (varicella) vaccine into their routine childhood immunisation programmes.

The implementation of the chickenpox vaccine on a national scale offers several benefits:

1. Reduction in cases: Widespread vaccination among children has the potential over time to significantly reduce the incidence of chickenpox, a highly contagious disease, among children and the wider community.

2. Prevention of complications: While chickenpox is often mild, it can lead to serious complications such as secondary bacterial infections, pneumonia and encephalitis; and can be particularly severe in immunocompromised individuals. Vaccination will help reduce the risk of these complications.

3. Healthcare burden: By reducing the number of chickenpox cases, the NHS can lower the associated healthcare burden, saving resources, GP consultations, urgent care capacity and hospital beds for other important healthcare needs.

4. Economic impact: Fewer chickenpox cases mean less time off from school for children and work for parents, positively affecting the economy and individual productivity, as well as educational outcomes for children and quality of life for families.

5. Herd immunity: Vaccination contributes to herd immunity, protecting those who are not  vaccinated or at higher risk of complications from chickenpox.

6. Health equity: Bringing the UK’s vaccination programme in line with other countries ensures that children in the UK benefit from the same level of healthcare protection.

The JCVI’s recommendation is based on evidence of the vaccine’s safety and effectiveness, making it a positive addition to the UK’s public health strategy. This decision underscores a commitment to safeguarding children’s health and reducing the impact of preventable diseases through immunisation once the governments in the UK and devolved nations accept the decision and start to implement the recommended vaccination programme.

How can the NHS provide personalised care to patients?

The objective for the NHS in England to provide high-quality, personalised care for all patients is a vision that requires a transformative approach to healthcare delivery. This shift signifies a move from the primarily finance and target-driven models of healthcare delivery that we have now to ones that are more patient-centred, emphasising the importance of individual patient needs and outcomes as well as the well-being of NHS staff.

In the international context, healthcare systems around the world are grappling with similar challenges: how to deliver care that is both high-quality and cost-effective, while also addressing the needs of an aging population and the rise of chronic diseases. Many countries are looking towards patient-centred care as a solution.

The World Health Organization (WHO) has also advocated for patient-centred care as part of its strategy to strengthen healthcare systems globally. It emphasizes that patient-centred approaches can lead to better health outcomes, more cost-effective services, and higher patient and staff satisfaction.

However, health systems globally faces unique challenges in implementing such care. For the NHS to adopt a patient-centred model successfully, it can draw on the lessons learned from these international experiences, adapting best practices to fit the unique context of the UK healthcare system. The global shift towards patient-centred care is not a fleeting trend but a response to the clear evidence that such approaches work. By adopting and adapting these international best practices, the NHS can continue to be a leader in healthcare delivery, providing care that is not only effective and efficient but also equitable and respectful of patients’ needs and values.

A more holistic approach to health care delivery would involve:

1. Patient-Centred Care: Tailoring treatment plans to the individual needs and preferences of patients, and ensuring that they are active participants in their own care. This would also involve respecting patient autonomy and decision-making.

2. Staff Well-being: Recognizing that the health and well-being of NHS staff are crucial to patient care. This would involve providing support systems, adequate staffing levels, and addressing burnout and job stress.

3. Quality Over Quantity: Instead of focusing just on meeting quotas and targets, the emphasis should be on the quality of care provided. This could mean more time for patient consultations, and follow-ups, and ensuring that treatments and interventions are evidence-based and help improve health outcomes for patients.

4. Integrated Care: Ensuring continuity of care across different services and providers, which require effective communication and collaboration among primary care, hospitals, mental health, community services, and social care.

5. Preventive Care: Shifting the focus of the NHS towards prevention and early intervention, which can improve long-term health outcomes and reduce the need for more intensive and expensive treatments later.

6. Accessibility and Inclusivity: Making healthcare services accessible to all sections of the population, particularly marginalised groups, thereby addressing health inequalities, and ensuring that healthcare is more equitable.

7. Investment in Staff Training: To deliver personalised care, there is a need for continuous professional development and training for NHS staff, equipping them with the skills to adapt to a more holistic and patient-focused approach.

8. Feedback and Improvement: Regularly collecting and acting on feedback from both patients and staff to improve services and care quality.

9. Technology and Innovation: Leveraging technology to improve patient care, such as through telemedicine, while also ensuring that it does not replace the human touch which is essential in providing compassionate care.

10. Mental Health Focus: Recognizing the mental health component as integral to overall health, ensuring that mental health services are as accessible and well-funded as physical health services.

To achieve this vision requires not only structural and policy changes within the NHS but also a cultural shift that values and prioritises the holistic well-being of patients and healthcare workers alike. This transformation can lead to a more sustainable health service that is better equipped to meet the current and future health needs of the population; such as addressing the health needs of older people and those with complex multimorbidity.

The path to a more patient-centred NHS is both a necessary and achievable evolution in healthcare delivery in England. By embracing a model that places the patient at the heart of care, values the well-being of healthcare staff, and integrates innovation with compassionate services, the NHS can not only enhance the health of individuals but also the health of our society.

This shift, grounded in the principles of accessibility, prevention, and personalised treatment, can forge a stronger, more resilient healthcare system that is equipped to meet the diverse and complex needs of the population in the 21st century. The future of the NHS, therefore, lies not only in numbers and targets, but in the quality of care and the health outcomes of its patients and the national population, marking a return to the core values that have long been the foundation of the NHS.

The essential role of daily exercise in enhancing health and well-being

Regular exercise is essential for good health, contributing to benefits that extend across the lifespan. In the United Kingdom, public health guidance emphasizes the importance of physical activity as a modifiable lifestyle factor that can significantly influence overall health and well-being.

Adults are advised to engage in at least 150 minutes of moderate-intensity activity each week, or 75 minutes of vigorous-intensity activity, along with strength exercises on two or more days a week that work all the major muscles.

Cardiovascular health sees marked improvements with regular physical activity. Exercise promotes heart efficiency, allowing it to pump blood more effectively, and reduces the risk of heart disease and stroke, which remain common health problems in the UK. Additionally, regular exercise can also help lower blood pressure and cholesterol levels, contributing to a healthier circulatory system.

Bones also benefit from exercise, particularly weight-bearing activities like walking, running, or resistance training. These activities stimulate bone formation and can help in reducing the risk of osteoporosis, a condition where bones become brittle and fragile. It’s especially crucial as one ages, because the risk of fractures and falls increases with age.

Mental health improvements are another significant benefit of regular exercise. Exercise can improve the symptoms of depression and anxiety through the release of endorphins, often referred to as ‘feel-good’ hormones. Physical activity can also lead to improved sleep patterns, greater energy levels, and enhanced cognitive function, which is increasingly important in the fast-paced modern world.

Incorporating just 30 minutes of exercise into your daily routine can be the catalyst for these health benefits. This could be as simple as a brisk walk, a cycle to work, or a morning swim. Making it a consistent part of your daily life can help establish a routine, making it more likely to stick as a habit. For those with busy schedules, breaking down the activity into shorter, 10-minute sessions can also be effective as well as being more manageable.

England’s National Health Service (NHS) provides resources and programs like ‘Couch to 5K’ to help people become more active. There is a strong emphasis on inclusivity, with guidance catering to all ages, abilities, and backgrounds, recognising that everyone stands to gain from the adoption of a more active lifestyle no matter what their age or individual characteristics.

Overall, the message from healthcare and public health professionals in the UK is clear: regular physical activity is essential for maintaining and improving health. As a professor of Primary Care and Public Health, I understand the importance of disseminating this message and empowering individuals to take control of their health through informed choices about physical activity. By making exercise a regular part of our daily lives, we can enhance our health, mood, and overall quality of life.

The Foundations of Good Health: Fruits, Vegetables, and Fibre

A diet rich in fruits and vegetables, complemented by a variety of high-fibre foods, is one of the foundations of good health. Eating at least five portions of fruits and vegetables daily is not just a number to aim for – it’s essential for a healthier life. Here’s a deeper dive into why these dietary staples are so crucial for your health:

1. The Powerhouse Pair: Fruits and Vegetables

Rich in essential vitamins, minerals, and dietary fibre, yet low in calories, fruits and vegetables are the unsung heroes of a health-conscious diet. Regular consumption of this dynamic duo can significantly diminish the risk of chronic conditions such as heart disease, hypertension, and certain cancers. The presence of vitamin C, along with a symphony of phytonutrients, bolsters the body’s health defences, offering a spectrum of benefits that go beyond basic nutrition.

2. The Fibre Effect: Sustenance and Protection

High-fibre foods act as the body’s natural sweep, promoting a robust digestive system and offering protection against cardiovascular diseases, strokes, type 2 diabetes, and colorectal cancer. The satiating nature of fibre aids in weight management by reducing the propensity to snack on high-calorie foods, thereby fostering a healthy weight profile.

Understanding Portions

A ‘portion‘ might seem abstract, but it translates into tangible items on your plate. For instance:

– A medium-sized apple or banana counts as one portion.

– A half-cup of chopped vegetables or fruit fits the bill.

– One cup of leafy salad greens or a quarter cup of dried fruit also qualifies.

– When it comes to high-fibre foods, think whole grains, beans, lentils, nuts, seeds, and of course, a variety of fruits and vegetables.

Diversity is Essential

Embracing a rainbow of fruits and vegetables ensures a broad spectrum of nutrients, each with its unique role in health and disease prevention. The different hues are indicative of the diverse vitamins, minerals, and antioxidants they contain, each contributing to the complex tapestry of a healthful diet.

Integrating Healthy Habits

Adopting a diet that includes these vital food groups is a significant step toward maintaining a healthy weight and mitigating the risk of chronic diseases. However, it’s most effective when part of a holistic approach to health that includes regular physical activity, avoiding tobacco, and other healthy lifestyle choices. By making these food groups a daily habit, we pave the way for better health.

The UK government must be more proactive about addressing drug shortages

In a letter published in the British Medical Journal, I discuss why the UK government must be more proactive about drug addressing shortages in the NHS.

The lack of drugs such as methylphenidate required for the treatment of attention deficit/hyperactivity disorder (ADHD) is the latest of many medication shortages we have seen in the UK in recent years.1 These shortages are now too frequent and waste the time of NHS staff such as general practitioners and pharmacists who have to spend time counselling patients and sourcing alternative drugs instead of focusing on more relevant work. They are also very stressful for patients who risk going without key drugs with potentially adverse consequences for their health. For people with ADHD, for example, this could mean going without medication that they require to function effectively at work and school and in their personal relationships.

We need a much more proactive approach from the government, which needs to work with drugs manufacturers and wholesalers to ensure that the NHS has adequate supplies of key drugs to prevent such problems occurring in the future. This could include better data on drug supply and demand to identify problems before they occur; improving local manufacturing capacity in the UK for essential drugs needed by the NHS; price incentives for suppliers; and international collaboration to ensure continuity of drug supply. Moreover, immediate support mechanisms should be put in place for primary care teams grappling with the increased workload caused by these shortages. Patients too could benefit from help such as national helplines or online support to allow them to cope better with the consequences of drug shortages.

Until we see active intervention by government, working in partnership with the NHS and industry, patients in the UK will continue to be affected and the time of NHS staff will continue to be wasted because of drug shortages.

Digital Tools for Enhancing Infectious Disease Screening in Migrants

The European Centre for Disease Control (ECDC) has highlighted a stark reality: migrants in Europe are disproportionately affected by undiagnosed infections, including tuberculosis, blood-borne viruses, and parasitic infections. Many migrants also fall into the category of being under-immunised. The call to action is clear — innovative strategies must be developed to deliver integrated multi-disease screening within primary care settings. Despite this call, the United Kingdom’s response remains fragmented. Our recent in-depth qualitative study published in the Journal of Migration and Health delves into the current practices, barriers, and potential solutions to this pressing public health issue.

Primary healthcare professionals from across the UK participated in two phases of this qualitative study through semi-structured telephone interviews. The first phase focused on clinical staff, including general practitioners, nurses, healthcare assistants, and pharmacists. The second phase targeted administrative staff, such as practice managers and receptionists. Through these interviews, a complex picture emerged, revealing a primary care system capable of effective screening but hamstrung by inconsistency and lack of standardized approaches. Many practices lack a systematic screening process, resulting in migrant patients not consistently receiving care based on established NICE/ECDC/UKHSA guidelines.

The barriers to effective infectious disease screening are multifaceted, stemming from patient, staff, and systemic levels. Clinicians and administrative staff pinpointed the stumbling blocks: overly complex care pathways, a lack of financial and expert support, and the need for significant administrative and clinical time investments. Solutions proposed by respondents include appointing infectious disease champions among patients and staff, providing targeted training and specialist support, simplifying care pathways, and introducing financial incentives.

Enter Health Catch-UP!., a collaboratively developed digital clinical decision-making tool designed to support multi-infection screening for migrant patients. The primary care professionals involved in the study responded enthusiastically to this digital innovation. They recognized its potential to systematize data integration and support clinical decision-making, thereby increasing knowledge, reducing missed screening opportunities, and normalizing infectious disease screening for migrants in primary care.

The conclusion is unequivocal: current implementation of infectious disease screening in migrant populations within UK primary care is suboptimal. Yet, there is hope. Digital tools like Health Catch-UP! could revolutionize disease detection and the effective implementation of screening guidance. However, for such digital innovations to succeed, they must be robustly tested and adequately resourced. It’s not just about having the right tools but also ensuring the entire healthcare system is aligned to support their deployment. With the right commitment, we can ensure that migrants receive the care they need and deserve, safeguarding both their individual health as well as public health in the UK.

Staying healthy this winter and making the most of the NHS

With England’s NHS under immense pressure even before the full onset of winter, here are some tips on how you can make the most of the NHS, use health services more appropriately, and obtain the care you and your family need to protect your health and wellbeing.

  1. Attend for appointments for medication reviews and for the management of long-term conditions when invited. This is important because it helps to ensure that your medication is up-to-date and that your condition is being managed effectively.
  2. Take-up the offer of Covid-19 and flu vaccinations if you are eligible. Vaccinations are the best way to protect yourself from these serious illnesses. Also take up any other NHS vaccinations you and your family are eligible for.
  3. Use the NHS app to book appointments, view your GP medical record and order repeat prescriptions. This is a convenient and efficient way to manage your healthcare.
  4. Be aware of the range of options for NHS care – including opticians, pharmacists, self-referral services (e.g., podiatry, Talking Therapies, smoking cessation), and NHS 111. This can help you to access the care you need quickly and easily.
  5. Use the NHS electronic prescription service so that your prescription is sent directly to a pharmacy. This can save you time and hassle.
  6. For queries about hospital care, contact the hospital Patient Advice and Liaison Service (PALS) team rather than your GP. The PALS team is there to help patients and their families with any concerns or questions they have about their hospital care. The contact details are usually present on the hospital’s website.
  7. Apply for online access to your hospital records if this is available. This can give you access to your medical information at any time, which can be helpful if you need to manage your own care or if you need to see a new doctor.
  8. Don’t Smoke. Smoking is a major risk factor for many diseases, including cancer, heart disease, and stroke.
  9. Exercise regularly including outdoors so that you get some sunlight exposure. Exercise is important for overall health and well-being, and sunlight exposure helps to produce vitamin D, which is essential for bone health.
  10. Eat 5 portions of fruit and vegetables every day and eat plenty of high-fibre foods. Eating a healthy diet is important for maintaining a healthy weight and reducing the risk of chronic diseases.
  11. Limit your sugar and salt intake. Consuming too much sugar and salt can increase the risk of obesity, heart disease, and other health problems.
  12. Limit your alcohol intake to a safe level. Consuming too much alcohol can damage the liver and increase the risk of other health problems.
  13. Take time to improve your mental health; including by meeting regularly with friends and family. Mental health is just as important as physical health, and it is important to take steps to protect and improve your mental well-being.
  14. Check your own blood pressure. High blood pressure is a major risk factor for stroke and heart disease, so it is important to monitor your blood pressure regularly.
  15. Take your medication as prescribed. It is important to take the correct dose of your medication at the correct time in order to get the best results.
  16. Stay Hydrated: Drinking enough water is crucial, especially when using heating systems that can dehydrate.
  17. Manage Stress: Stress can have a negative impact on your immune system. Consider incorporating mindfulness or relaxation techniques into your daily routine.
  18. Telemedicine: Use telehealth options when appropriate, to save time and minimise exposure to potential infections.
  19. First Aid Kit: Keep a well-stocked first aid kit and know how to use the basic items. This can be particularly useful for minor injuries and illnesses.
  20. Home Safety: Falls and accidents are common during the winter due to icy conditions. Making your home slip-proof can prevent unnecessary hospital visits.
  21. Keep Emergency Numbers Handy: Important contact numbers should be easily accessible, whether it’s on your fridge or saved in your phone.
  22. Regular Hand Washing: Promote good hand hygiene, especially if interacting with vulnerable populations like the elderly or very young.
  23. Know the Signs of More Serious Conditions: Understanding the early symptoms of conditions like strokes, heart attacks, and other acute illnesses can save precious time in an emergency.
  24. Air Quality: Try to keep up the air quality in your home and at work; for example, through ventilation.
  25. Supplement Vitamin D: Sunlight exposure may be limited, so consider vitamin D supplementation if you are in a group that this is recommended for.
  26. Community Support: If possible, check on neighbours and family members who might be vulnerable during the winter months, whether due to age, health conditions, or social isolation.
  27. Use of Over-the-Counter (OTC) Medication: Understand when to use OTC medications for minor illnesses and when to seek professional advice.
  28. Get a good night’s sleep. Sleep is essential for good health, so it is important to get at least 7-8 hours of sleep each night.
  29. Listen to experts on health issues and not random people on social media. There is a lot of misinformation about health issues circulating on social media, so it is important to get your health information from reliable sources, such as the NHS website or healthcare professionals.