As the seasons shift here in the UK to embrace autumn, more people will seek advice for coughs, sore throats, and hoarseness, but are you up to date on laryngitis? In their clinical review, an Australian ENT team present the diagnostic challenge of this condition, outlining the red flag symptoms to prompt investigation for malignancy—very timely for mouth cancer awareness month in November.

The review includes some informative videos by Philippa Ratcliffe, a consultant speech therapist from UCLH, who gives advice on vocal hygiene and the importance of vocal assessment.

The review also discusses the link between gastro-oesophageal reflux and laryngitis, and questions the still controversial use of proton pump inhibitors (PPI) for throat symptoms—the topic of a recent practice article, which similarly concluded that evidence is limited and suggested alternative management.

In a personal view, Simon Bowers, GP and clinical vice chair of Liverpool clinical commissioning group, explains why he feels we are failing children with ADHD. He promotes the formulation of an ADHD pathway to improve outcomes, not just in health but in education, the welfare state, criminal justice, and the economy. Thus, challenging how we should measure successful management of a patient’s condition.

In the spirit of challenging, Margaret McCartney raises her concerns about the power of the GMC, and whether its proposed sanctions for doctors are really the answer to issues affecting patient care. She wonders “where are the ‘serious’ sanctions for managers who don’t hire enough staff, or for politicians who create a constantly distracting sea of boxes to tick when we should be listening to patients.”

Patients will be listened to through the new NHS England initiative announced by Jeremy Hunt today. This programme, prompted by Don Berwick’s report, will see the creation of 15 regional patient safety collaboratives. Those behind the initiative hope that these collaboratives will empower staff and patients to jointly address local safety issues, with successful ideas shared and spread across the NHS.

Not all NHS initiatives are met with such enthusiasm, as can be seen from the increasing unrest from Conservative politicians publically criticising changes made under the Health and Social Care Act 2012. For a better understanding of the act’s possible impact, why not listen to our latest podcast. Helen Macdonald, our analysis editor, is joined by Allyson Pollock (professor of global health) and Peter Roderick (a barrister), who explain the basis for their concerns that NHS services will be “whittled down” under the act.

Emma Parish is editorial registrar, The BMJ.