Hugh Pym
Health editor

We visited Leicester Royal Infirmary over two days, the busiest emergency department in England. More than 900 patients are coming through the doors each day, many with respiratory conditions including flu.

Richard Mitchell has been the chief executive of University Hospitals Leicester NHS Trust since 2021 - and has witnessed first-hand how it gets harder to cope with each winter that passes.

"We are already seeing very high levels of flu," he tells us. He expects numbers to climb into January. "That is one of the many things I am concerned about at the moment.

"At this point I feel we are working at the limits of our ability."

The trust has taken over a former care home in Leicester and has created extra beds for less seriously ill patients.

But managers are bracing for intense pressure in the new year, which is always the busiest time for the NHS.

Claire McAllister
BBC Scotland health reporter

Image source, Getty Images

Most Scottish health boards are now asking people to wear masks when they visit hospitals.

It comes as the number of people admitted to hospital because of the flu has risen for the sixth week in a row.

The rate has started to slow, but it is still adding pressure on the NHS Scotland at a busy time of year.

People are being urged to get vaccinated to protect against severe illness, but some community pharmacies have run out of private flu jabs and are struggling to replenish stocks.

Officials say there are still plenty of NHS supplies.

Image source, PA Media

Like other parts of the UK, flu cases have been rising quickly in Northern Ireland.

Figures published today, external show there were 1,184 new cases in the first week of December - a 24% increase on the previous week.

Children and young people have been particularly affected.

A paediatric emergency medicine consultant previously told the BBC this winter was the "most severe influenza outbreak" she has experienced.

Health trusts across Northern Ireland are asking people attending hospitals to wear masks due to the high levels of flu.

Michelle Roberts
Health editor, BBC News online

Flu is not the only respiratory infection doing the rounds at the moment.

People are still catching Covid and other viruses.

If you have a cough and a high temperature it could be any of a number of infections. Your symptoms can give a clue.

Flu is far worse than a cold and tends to come on quickly and make you feel very ill – you would struggle to get out of bed. Covid can feel a bit like flu, but you may have other symptoms such as loss of taste or smell and an upset stomach.

Young babies and older adults may have caught an illness called RSV or respiratory syncytial virus which is very common at this time of year.

All of the infections are spread by coughs and sneezes, so practising good hygiene – washing your hands frequently – can help stop the spread.

Elliot Burrin
Live reporter

Image source, Olivier Picard

Olivier Picard is a pharmacist who manages four branches in Berkshire. He tells me he's never seen a December with this high a demand for flu vaccines.

He says demand usually peaks in October, so it's "very unusual" for him to buy more vaccines in December.

This year he's even administered vaccines to people who've said they were turned away elsewhere due to there being no more vaccines ready.

Picard says his branches were able to open extra appointments on the national booking system and take walk-ins, helping to lift the pressure elsewhere.

Charlotte Hadfield
Live reporter

Image source, Getty images John Hand

What's going on?

The number of flu patients in hospital in England has reached record levels for this time of year in what NHS England describes as an "unprecedented situation”.

• An average of 2,660 patients a day were in hospital with flu in England last week – an increase of 55% on the week before
• Last week, hospital admissions for flu in Scotland rose by 15% from 860 to 986
• In Wales, 254 patients were in hospital with flu in the week up to December 7 - with 12 of those needing critical care

What can you do?

• The NHS is urging anyone eligible to get their flu vaccination to help prevent them getting seriously ill
• This includes people aged 65 or over, those living with certain long-term health conditions, pregnant women and care home residents
• The PM says the government is not changing the guidance on face masks, while the UKHSA says people should "consider" wearing face coverings when flu rates are rising

What does this mean?

• Professor Meghana Pandit, national medical director at the NHS, says “this unprecedented wave of super flu is leaving the NHS facing a worst-case scenario for this time of year”
• Staff are "being pushed to the limit to keep providing the best possible care for patients"
• Our health correspondent looks at how much pressure hospitals are under

Michelle Roberts
Health editor, BBC News online

Most people who catch flu make a full recovery after a week or two with some rest at home.

But some may need emergency care. People who are more vulnerable – such as those with existing chronic health problems – can develop serious and even potentially life-threatening complications, such as pneumonia.

You should contact your doctor or call NHS 111 if you feel very unwell and you are worried.

If you get sudden chest pain or difficulty breathing, seek urgent medical help. Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance. Bring any medicines you take with you.

The prime minister has said the government is "not changing the guidance on face masks".

As we mentioned in our previous post, the advice from UKHSA is that wearing a mask is something people with flu-like symptoms should "consider" when rates are rising.

"We're not changing the guidance on face masks, but the usual things about ventilation, washing hands and just being careful when you're around people who are vulnerable – is the guidance," he tells reporters.

"It's common sense and I think most people would want to behave in that way."

More generally regarding flu, he says there is a winter plan in place. He also thanks NHS staff who "always step up" during the winter period.

Jim Reed
Health reporter

Image source, Getty

All this talk of surging "super-flu" has revived the pandemic-era debate about mask wearing.

A number of hospitals, from Bath to Bradford to Surrey, have been asking patients and visitors to wear surgical masks when they arrive in A&E or in certain departments.

The longstanding advice from the UK Health Security Agency (UKHSA) is that wearing a mask is something people with flu-like symptoms should "consider" when rates are rising.

But speaking to Times Radio this week, Daniel Elkeles, the boss of NHS Providers, which represents NHS trusts, went further saying that people with symptoms like aches and a fever "must" start wearing a face covering in public.

"We were all very good about infection control during Covid and we really, really need to get back to that now," he said.

UKHSA , externalsays that a mask can both protect the wearer from infection and, if used by someone with symptoms, can reduce the number of virus particles being released from the mouth and nose.

Owain Clarke
BBC Wales Health Correspondent

The number of flu cases in Wales rose sharply during first week of December.

There were a total of 254 patients in hospital with flu last week – with 12 of those needing critical care.

Due to a lag between collecting the statistics and publishing them, the current rate of flu in Wales is likely to be higher and is significantly higher than the same point last year.

Public Health Wales says it is "seeing significant numbers of cases of flu in all age groups, but currently especially in children and adolescents".

But it says the flu vaccine this year is proving to be effective for younger people in offering protection against severe disease.

Earlier this week Wales' chief medical officer reminded parents of children who had missed school vaccination sessions that it is not too late to arrange another before Christmas.

There's still a "good availability" of flu vaccines in local pharmacies, according to the National Pharmacy Association.

Head of Pharmacy Advice Jasmine Shah says member pharmacies have enough stock to vaccinate patients "promptly". The association represents over 6,000 pharmacies in the UK.

There is no general shortage of flu jabs in local independent pharmacies, she says – but some primary care providers have temporarily run out of stock.

"We urge people in at risk groups, such as older people and pregnant women, to get vaccinated as soon as possible," Shah says.

Katy Scott
BBC Scotland news

Public Health Scotland (PHS) says Scotland has now reached the high activity threshold for flu earlier than previous seasons.

Last week's figures showed cases had more than doubled in the space of a week.

Some Scottish health boards have had to close wards and restrict visiting, with many asking people to wear masks.

Meanwhile a number of schools in Aberdeenshire have reduced their hours due to flu-related illness, with pupils taking online lessons at home.

However PHS says its latest flu data shows that the vaccine was preventing severe flu, with children 78% less likely to be admitted to hospital if vaccinated.

It says vaccinated adults in Scotland aged 65 and over were 37% less likely to be hospitalised.

Dr Kim Marsh from PHS said: "Vaccination remains the best way to help protect yourself against serious illness from flu and is also important in reducing the spread of flu in the community."

Data paints picture of NHS under pressurepublished at 11:33 GMT

11:33 GMT

Jim Reed
Health reporter

The NHS in England is dealing with a 55% jump in flu patients needing hospital treatment in a week.

That comes as other winter pressures start to build.

Last week 32% of patients arriving in an ambulance had to wait at least half an hour to be handed over to hospital teams, up from 30% in the previous week.

When they get to A&E, 74.2% of patients were seen within the target time of four hours in November, according to new figures this morning. That's up very slightly from the 74.1% in October.

And the number of the sickest patients stuck in A&E departments for more than 12 hours before they can be admitted to a hospital ward, so-called "corridor care", stood at 50,648 in November, down from 54,314 in October.

New data also shows the waiting list for pre-booked treatment such as non-emergency surgery had risen slightly to 7.4m by the end of October, up from 7.39m in September.

Katy Scott
BBC Scotland news

Pharmacies in Scotland have warned that private stocks of flu vaccines are running low.

It comes as lab-confirmed cases in the country rose by a quarter from 1,875 to 2,331, according to the latest figures from Public Health Scotland (PHS), external.

In the week of 1-7 December, hospital admissions for flu in Scotland increased by 15% from 860 to 986.

Those eligible for a vaccine can access jabs from the NHS, but Community Pharmacy Scotland says that people have been paying for the vaccine at pharmacies for convenience.

"It's a mixture," says policy and development head Adam Osprey.

"Some people are saying to us that they are running low while others have completely run out and have not got much hope of getting the stock back in."

Michelle Roberts
Health editor, BBC News online

Flu has come early this winter, and it looks to be a particularly nasty season because of a new mutated version of the virus which is circulating, say experts.

People have not encountered much of it in recent years, which means there is less built up immunity against it in the community.

For these reasons, many are now calling it "super flu", but it is not more severe or harder to treat.

It is actually a type of seasonal influenza A virus called H3N2 "subclade K". Vaccines should still work well to help protect people.

The surge in flu cases comes at a time when hospitals are already struggling with capacity.

New monthly figures show A&E attendances hit a record high of 2.35 million in November – more than 30,000 higher than a year ago.

There were also 48,814 more ambulance incidents compared to November last year.

Meanwhile, resident doctors are threatening to go on strike from 17-22 December – although this could be averted by a last-minute offer from the government.

The BBC was recently given access to Leicester Royal Infirmary's acute unit to witness first-hand how it is coping with an early surge of winter bug cases.

All of the beds were full by midday, staff were primed to turn rooms around as soon as patients left, and one patient described waiting 106 hours for a bed on a ward.

Is this flu wave actually unprecedented?published at 10:54 GMT

10:54 GMT

Nick Triggle
Health correspondent

NHS England says the number of patients with flu in hospital is the worst on record for this time of year, describing it as an unprecedented situation.

It is, but that's because the data only goes back to 2021-22. In doing so, it misses several really difficult flu seasons during the 2010s.

The 2014-15 and 2017-18 winters were particularly bad – more than 20,000 deaths from flu were recorded.

Both were far worse than what we have seen over the past four years.

So when the NHS talks about being in an unprecedented situation it is not taking into account what happened just a decade ago.

Could this flu season match those? It is quite possible. The strain that is dominant this year –H3N2 – was the one behind the 2014-15 and 2017-18 spikes.

But it is worth remembering what is being seen now is not something that has never happened before.

If you have symptoms – such as coughing and sneezing – there are a few steps you should take to prevent the spread, says Dr Suzanna McDonald, who is the national lead for the influenza programme at the UK Health Security Agency.

"You can consider wearing a face mask," she says, but the "first thing you should do to limit the spread of infection is stay at home."

"In particular, you need to avoid mixing with anyone who might be more vulnerable if they were to catch flu," she tells BBC Radio 4's Today programme.

If you do need to leave home, McDonald advises sticking to outdoor spaces or ensuring places indoors are well ventilated – by opening windows for instance.

Covering your coughs or sneezes with a tissue – and washing your hands after – are must-dos, she adds.

McDonald also says if you're considering getting a flu jab, there are no national shortages of vaccine stock.

All will make you feel run-down, but the symptoms for each differ slightly:

How much pressure are hospitals under?published at 10:23 GMT

10:23 GMT

Nick Triggle
Health correspondent

This is always the busiest time of year for the NHS.

The number of patients in hospital with flu in England – an average of 2,660 a day last week – means nearly 3% of beds are occupied by people with the virus.

That may not sound a lot, but before this wave of flu hit the NHS already had more than 90% of its bed occupied.

With projections showing the numbers could go up to between 5,000 and 8,000 by the end of this week, it's easy to understand why NHS bosses are so worried.

This will almost certainly end up the worst flu season for many years and with a five-day walkout by resident doctors, the new name for junior doctors, due to start next week hospitals are facing multiple challenges.