NHS staff fatigue is not recognised as a serious risk to patient safety, according to a new report by the Health Services Safety Investigations Body (HSSIB).
The report looked at the impact of staff fatigue on patient safety in acute hospital trusts.
It found that fatigue was linked to preventable patient harm and staff safety incidents, both directly and indirectly, including road accidents where NHS colleagues had lost their lives. But that there were barriers to understanding the size and scale of the issue.
It said there was ‘little evidence available’ to understand the scale of impact, and that the healthcare sector ‘lacks robust systems’ to monitor and manage the issue.
The report added that there were various ‘cultural norms’ in the NHS such as pride, heroism and long working hours which discouraged open conversations about fatigue, and that often it was seen as an individual’s risk with limited organisational accountability.
The report, which used interviews, site visits, national data and expert insight, focused on acute NHS hospital trusts and in some cases included those providing community services. However, it said the learning would be relevant to providers and staff across other health and care settings.
It recommended that NHS England and the Department of Health and Social Care (DHSC) identify and review current processes that capture staff fatigue related data in order to enhance the understanding of fatigue risk. This should help inform future strategy and action to address the issue, it added.
A second recommendation also called for the development of a consensus statement defining fatigue for healthcare staff.
‘This will help to support a consistent understanding of fatigue among healthcare providers and improve the understanding of factors that may impact on staff fatigue and patient safety,’ it said.
Saskia Fursland, senior safety investigator at HSSIB, 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.
‘Awareness of the risks that staff fatigue poses to patient safety is beginning to grow within healthcare, but our investigation found that understanding remains inconsistent and fragmented. This challenge is further compounded by limited data and the absence of coordinated national oversight – factors that significantly hinder effective risk management.
‘As the NHS prepares for reform, the report underscores the need for strong, unified action to protect both patients and healthcare professionals from the risks associated with fatigue.’
Responding to the report, the interim chief executive of NHS Providers, Saffron Cordery, said: ‘The link between tired staff and patient harm is clear, and we know trusts are worried about staff wellbeing and the impact on patients.
‘In recent years staff have faced mounting workload pressures including growing and increasingly complex demand for care, often in overcrowded or under-resourced facilities, and in the face of severe staff shortages.
‘These concerns came through loud and clear in the NHS staff survey, and there’s no sign of any let-up.’
She added that steps to protect and enhance staff wellbeing and reduce the risk of fatigue ‘must be a priority at every level’.
‘HSSIB is right to highlight the potential risks associated with staff fatigue in implementing national initiatives on workforce challenges and care delays,’ she said.
‘The forthcoming refreshed NHS Long Term Workforce Plan offers an opportunity to address and improve staff wellbeing.’
This week, a study by the University of Manchester found that GPs in the most deprived areas in England on average earn £5,525 less a year than those in more affluent areas.
GP practices in areas of socioeconomic deprivation face ‘increased job pressures’ related to managing complex patients, insufficient resources and difficulty in finding locum cover, the analysis showed.
It comes as ICBs have been told to make 50% cuts, with some asking for permission to merge, according to the health secretary Wes Streeting.
