The dangers of fatigue in the healthcare setting

In safety critical industries, such as healthcare, it is important to recognise the mechanisms for managing the many areas of risk to both staff and patients. Staff are one of the most important elements of the NHS and are its most critical asset. The major ways to ensure a happy and healthy workforce is to look after them. This was undertaken during COVID-19, as far as was possible, but has since been dropped from the operational guidance, since the pandemic. Fatigue — both acute and chronic — are aspects of staff experience which have received little attention, specifically relating to errors and patient safety. This is gaining traction now — with shortages of staff, pressure to deliver on the backlog, and degradation in cognitive performance, all contributing to patient safety incidents.

The Health Services Safety Investigations Body (HSSIB) has recently produced a report¹ looking specifically at the impact of fatigue on staff and patient safety. The narrow aspect of the report, however important, indicates this should be put into a broader context of the present conditions of service, which staff and patients are experiencing in the NHS.

The NHS needs Trusts to have the right number of staff in the right roles at the correct times and in the appropriate locations. This is hardly possible at this time, due to the number of vacancies across the NHS. Staff shortages, combined with workload pressures, add significantly to stress experienced by individual workers, particularly (but not exclusively) professional frontline staff. It directly affects the quality and safety of care delivered and staff regularly report that they are unable to deliver the quality of care that they wish to. Staff say that there are insufficient numbers of staff to deliver safe care on two-thirds (69%) of shifts.² It is known that Trusts are being encouraged to reduce the number of locum and agency staff to fill short-term vacancies and shifts on a cost basis. This is based on a framework agreement between NHS England and each Trust, and is agreed and reviewed regularly to reduce expenditure.³ The option that Trusts have is to increase their use of bank staff — which, in turn, can lead to excessive fatigue, as there is little oversight of the number of hours individual staff are working.