Jessica O'ConnorFatigue among NHS staff is directly contributing to patient harm, but a lack of systemic oversight and understanding is leaving trusts ill-equipped to address the growing risk, according to a report from the Health Services Safety Investigations Body (HSSIB).
The investigation, which involved extensive engagement with healthcare professionals across acute hospitals in England, found that the impact of staff fatigue on both patient safety and workforce wellbeing is not being adequately captured or addressed within current NHS systems.
Interviews, observational visits, and data from national bodies revealed significant gaps in how fatigue is understood and managed across the healthcare sector.
Despite clear evidence that staff fatigue can contribute to clinical errors and harm, the report found a lack of consistent recognition across NHS trusts.
Many organisations lacked the data or systems necessary to properly assess fatigue risks, and those that had begun exploring the issue were in the minority.
The findings suggested that fatigue is often seen as a personal issue, rather than an organisational responsibility, leading to a culture where staff are blamed or penalised instead of supported.
The report highlighted that fatigue in NHS staff is driven by a complex mix of personal and organisational factors.
These include long shifts, high workloads, insufficient rest breaks and facilities, as well as personal circumstances such as pregnancy, caring responsibilities, and socioeconomic pressures.
One particularly alarming risk linked to fatigue was staff being involved in car accidents or near misses after driving home from exhausting shifts.
A pervasive ‘hero culture’ and outdated norms around working long hours were also identified as barriers to acknowledging fatigue as a safety risk.
Meanwhile, existing demands on healthcare services, combined with financial and staffing constraints, were found to limit many organisations’ capacity to address the issue meaningfully.
Despite these challenges, the report identified that a positive safety culture within healthcare organisations can significantly improve their ability to manage fatigue risk.
It also recognised the value of national initiatives such as the NHS England Patient Safety Incident Response Framework (PSIRF), which has helped some trusts begin to consider fatigue in safety investigations, although this is not yet a routine practice.
The report found that there is little regulatory oversight at the national level when it comes to the risks posed by staff fatigue.
It also noted that efforts to tackle workforce challenges and service delays rarely consider the safety implications of exhausted staff.
In response to its findings, HSSIB issued several recommendations and observations aimed at NHS England, the Department of Health and Social Care, and other national stakeholders.
These included a call for a comprehensive review of how staff fatigue data is captured and used, and the development of a nationally agreed definition of fatigue in healthcare settings to promote a shared understanding.
The report also urged research bodies to prioritise investigations into the impact of fatigue on patient outcomes, and encourages healthcare organisations to include fatigue-related questions in staff surveys.
Additionally, it called on professional and regulatory bodies to support the spread of best practices for managing fatigue and to consider fatigue-related factors when conducting assessments or taking disciplinary action.
Finally, the report recommended that healthcare providers look to adopt systems-based approaches to fatigue risk management, such as those laid out by the Chartered Institute of Ergonomics and Human Factors.
