Exhausted hospital staff putting patients at risk, says watchdog

Extreme tiredness and exhaustion among NHS staff poses a significant risk to patients, England's NHS safety watchdog warns.

The Health Services Safety Investigations Body said medication errors, impaired decision-making, reduced attention and rude and disrespectful behaviour were the most common problems associated with fatigued staff in hospitals.

It said there was limited data on the scale of the problem, but cited evidence from staff surveys and information provided by safety experts that it was a contributory factor in safety incidents.

In its report, the watchdog gave examples of mistakes being made with pregnancy scans and chemotherapy drugs.

In one case a mother and baby were harmed after an inaccurate scan, with the staff member saying fatigue and workload contributed.

In the chemotherapy case the staff were nearly nine hours into a 12.5-hour day shift and had only managed five to six hours of sleep between shifts and had limited breaks because of staffing pressures.

The hospital investigation found fatigue was "likely to have been a factor".

Some staff reported being sleep-deprived on a daily basis.

And one doctor told the watchdog: "When it gets to that third day of doing these 12-hour nights it's dangerous from 2am onwards... do I have the energy or the brain space or the mental space to even make a life-changing decision for a patient at this point?"

The watchdog said exhaustion was also a risk to staff themselves with some complaining of nodding off at the wheel on the way home and reports of staff dying in road accidents after work.

Shift work, long working hours, lack of breaks, caring responsibilities and financial pressures were all cited as factors in staff fatigue.

The watchdog said the issue was often misunderstood in the NHS and thought of more as a wellbeing issue rather than a safety issue.

It said the government and NHS England needed to introduce better systems to monitor fatigue and work with unions and employers to raise awareness about it.

Senior safety investigator Saskia Fursland said: "Fatigue is more than just being tired - it can significantly impair decision-making, motor skills, and alertness.

"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."

Dr Latifa Patel, of the British Medical Association, said the findings were concerning, but not surprising with doctors facing long shifts back-to-back with little respite.

She said there needed to be better rota design to ensure staff could rest properly between shifts and improved rest facilities in hospitals.

But she said fatigue was also "often driven by workforce shortages" too.

A spokesperson for NHS England said it recognised staff were at risk of burnout and was "committed" to ensuring they got the support they needed to provide safe care.

"Staff should always feel confident to report patient safety concerns, including those that are linked to fatigue, and we will work with local NHS systems to address any issues," he added.

He said the NHS was offering more flexible working options than ever before and there was a range of mental health support available for staff.

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