Workforce issues
The dangers of fatigue in the healthcare setting
Kate Woodhead warns that fatigue is an unexplored factor in patient and staff safety in healthcare. In this article, she reflects on the findings of the latest Health Services Safety Investigations Body’s report, which looks at the impact of fatigue.
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.
Staff shortages 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.
A survey undertaken in 2021 of nearly five thousand staff in the NHS found that 47.5% felt their work was undervalued by the government, 20.6% felt undervalued by their employer and 17.7% by the public.
The Long-Term Workforce Plan, published under the last government, identified that they would train significantly more professional staff (backed by £2.4 billion), as well as focusing on the retention of existing staff by: allowing greater flexibility; ensuring career progression; and improving culture, leadership and well- being, while continuing to focus on equality and inclusion. They also identified that they would reform the ways that are worked so that healthcare staff have the right multi- disciplinary skills in order to add new digital and technological innovations to enable the staff to focus on delivering patient care. It is unlikely in the view of this author that all of these elements will be supported going forward, by the new Department of Health and Social Care.
Working conditions A survey undertaken in 2021 of nearly five thousand staff in the NHS found that 47.5% felt their work was undervalued by the government; 20.6% felt undervalued by their employer; and
June 2025 I
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