Fight Fatigue – what still needs to be done
Tackling fatigue must be a priority for the NHS. A poor fatigue culture adversely affects patient safety and staff safety and wellbeing.
The Joint Working Group’s #FightFatigue campaign which launched in 2017 aims to improve the culture around fatigue in the medical profession and influence safer working conditions for healthcare professionals.
As part of our campaign, between 2016 and 2019 we surveyed all grades of anaesthetists and documented the scale of the issue of fatigue, including:
- 57% of trainees have had an accident or near miss driving home after a night shift and over 60% of all grades responding to our surveys reported feeling too tired to drive
- Nine out of ten consultants and SAS doctors described experiencing work-related fatigue with significant impact on their health and wellbeing
- Access to rest facilities is limited with over one third of trainees and SAS doctors having no access to on-shift facilities.
Since these surveys, anaesthetists and intensivists have been on the front line in the response to a global pandemic and the NHS is now trying to manage a huge backlog of an estimated 7 million patients waiting for elective procedures. Progress has been made and the importance of looking after staff is well recognised by many partner organisations, but staff are still working with the consequences of the pandemic.
Demands for health services remain relentless. Operational targets are driving pressures constantly to do more with less, which means relatively fewer people doing more work. It is no surprise that sickness rates are increasing, and we are seeing increasing numbers of trainees choosing to work Less Than Full Time. These are the same staff who have worked through the pandemic – so this is not a lack of resilience. This is due to chronic excessive workload, constant change, and a lack of attention to the basic needs of staff.
The GMC in their workforce report published in October laid bare the challenge in stark terms [1]. It showed that “dissatisfaction with role, place of work or NHS culture” was the most commonly cited reason for leaving the profession, with burnout and work-related stress also prominent. The GMC commented that consideration “must be given to whether these higher rates of [staff] leaving are likely to continue. The increasingly high levels of burnout…suggest this could be a risk.” Burnout and fatigue are related issues, both of which need, and must, be tackled.
Providing adequate working conditions for staff must be central to the solution. Staff must have their basic physiological needs met. The vast majority of other 24-hour safety critical industries such as rail and aviation include fatigue risk management systems as part of their mandatory safety policies to limit and manage the risks of staff fatigue. NHS staff should have the same protection; we have the same physiological need for sleep. This means:
- Working patterns with adequate time to rest, recover and recharge between shifts
- To be able and supported to take regular breaks at work
- To have somewhere to rest, including to have a power nap, during their breaks
- To be able to travel to and from work safely
This is not too much to ask. If the NHS can demonstrate humanity to its staff, its staff can demonstrate humanity to their patients.
Recently, the Academy of Medical Royal Colleges released a report ‘Why we must stop normalising the unacceptable’ in which they called for “an open and honest national conversation among politicians, patients and the public, healthcare professionals and policy makers, one which leads to action and meaningful change”[2].
So, what do we need to do?
- We need measures to improve the working conditions of NHS staff placed at the forefront of healthcare policy, including recruitment and retention of staff – the partner organisations will continue to advocate and campaign for this.
- We must stop asking staff to work unsafe rotas. Contractual protections against fatigue are included in the 2016 junior doctor contract and 2021 SAS contracts. When these are not met, they should be reported via the exception reporting system or SAS advocate role. For consultants and SAS doctors, fatigue should be considered at job plan reviews.
- We must provide adequate rest facilities for staff as set out in our standards and we would like to encourage departments to contribute to the national audit of rest faculties and culture currently being led by SCATA.
We need everyone to work together to support the NHS, to recognise that it is staff who make the NHS function and prioritise measures to improve their working conditions. We need to look after staff so they can look after their patients. We need to get the basics right.
Emma Plunkett
Nancy Redfern
Co-chairs, Association of Anaesthetists, Royal College of
Anaesthetists and Faculty of Intensive Care Medicine joint
Fatigue Working Group
References
- General Medical Council. The state of medical education
and practice in the UK: the workforce report 2022, 2022.
https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk/workforce-report-2022 (accessed 31/12/2022).
- Academy of Medical Royal Colleges. Fixing the NHS: why
we must stop normalising the unacceptable, 2022.
https://www.aomrc.org.uk/reports-guidance/fixing-the-nhs-why-we-must-stop-normalising-the-unacceptable/ (accessed 31/12/2022).