A new report from HSSIB finds that fatigue in healthcare is still seen as an issue of personal responsibility rather than a risk that endangers patients and staff.
Fatigue amongst NHS healthcare staff poses a significant yet under-recognised risk to patient safety, warns the English safety watchdog.
The Health Services Safety Investigations Body (HSSIB) has examined the impact of staff fatigue in healthcare on patient safety. It found, despite some data from surveys and staff anecdotes on exhaustion and fatigue, there is still little evidence available to help understand the size and scale of the problem, the scale of its impact on patient safety and those staff who are at most at risk from fatigue.
The healthcare sector lacks robust systems to monitor and manage this issue, even as demands on the NHS workforce become more challenging and intense.
The report highlights that fatigue in healthcare is often misunderstood, and viewed primarily as a well-being concern rather than a critical patient or staff safety risk.
“Fatigue is more than just being tired – it can significantly impair decision-making, motor skills, and alertness,” said Saskia Fursland, senior safety investigator at HSSIB.
“We must move away from viewing fatigue as an individual issue and putting the onus on personal responsibility and instead treat it as a system-level risk that deserves urgent attention.”
Strong action required
The report highlights four areas of concern.
First, fatigue is linked to preventable patient harm and staff safety incidents, including fatal road accidents post-shift. Staff who spoke to HSSIB spoke of colleagues they had known who had lost their lives in road accidents where fatigue was thought to be a contributory factor.
Organisational and personal factors are also mentioned. Issues like shift length, lack of breaks, caring responsibilities and socioeconomic pressures all contribute to fatigue.
None of this is helped by a culture of celebrating fatigue in the NHS. A pride – the report uses the word “heroism” – in long working hours and discouragement of open conversations about fatigue.
Finally, fatigue risks are not consistently captured in data or addressed in governance or safety learning systems. There is also limited consideration of the risk of staff fatigue in national initiatives addressing workforce challenges and care delays.
The report concludes with two recommendations – that data capture mechanisms on fatigue be improved and that a consensus definition of fatigue for healthcare be established.
“The report underscores the need for strong, unified action to protect both patients and healthcare professionals from the risks associated with fatigue,” said Fursland.
Day-to-day reality
It is a sign of how serious an issue this is, that the report was welcomed by insurers almost immediately.
“We are pleased that the HSSIB’s report recognises the importance and impact of staff fatigue on patient safety,” said Michael Devlin, head of professional standards and liaison at not-for-profit medical defence organisation Medical Defence Union (MDU).
“It is troubling that there has been so little evidence gathered to identify the scale and scope of the problem, despite the introduction in the NHS of new investigation methods, such as the systems approaches in the Patient Safety Incident Response Framework.”
The findings of the HSSIB report echo those from an MDU report in March which highlighted that nearly 90% of respondents said that they feel sleep-deprived at work and another, earlier this month from the Medical Protection Society (MPS). It reported that three in five (60%) doctors said they have continued to work when not feeling mentally well enough because they feel guilty adding to colleagues’ workloads, and half (50%) cited staff shortages.
Rob Hendry, chief member officer at MPS said that the HSSIB report summed up the “day-to-day reality for most NHS workers”.
It also welcomed the call for a review better to understand the risks and inform a strategy to tackle the issue.
“In the meantime, NHS employers must consider how they can encourage and better facilitate staff to take breaks, hydrate, and rest before shifts so they can continue to care for patients safely,” he said.
