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NHS staff are so tired they are dying in car crashes and posing a major threat to patients, the service’s safety watchdog will warn on Thursday.
Fatigue among frontline personnel causing them to make mistakes is a “significant” risk to patients, according to the Health Services Safety Investigation Body (HSSIB).
It “contributes directly and indirectly to patient harm”, yet is not properly appreciated as a risk by the NHS, possibly because of the perceived “heroism” of NHS staff.
Exhaustion has led to doctors and nurses harming patients by inserting feeding tubes in the wrong place, leaving swabs inside a woman who had just given birth and mislabelling blood samples.
But the NHS safety regulator for England also found that staff who are driving home after finishing a long shift could die in a road accident because they are extremely tired.
“Fatigue was found to have a negative impact on staff safety,” the HSSIB said in a report, which is based on interviews with about 100 staff and evidence from national organisations.
“A key risk related to this was staff driving home after a long shift and being involved in fatal car accidents or near misses.”
Organisations representing doctors have highlighted that danger after a number of medics died in such circumstances, including Dr Ronak Patel, a trainee anaesthetist, in 2015.
His death prompted the Association of Anaesthetists to launch a campaign to raise awareness of how common such incidents are and to demand that NHS organisations do more to safeguard the welfare of staff doing night shifts, for example by giving them somewhere to have a nap before going home.
Patel, who was 33, was singing to his wife, Helen, on a hands-free phone while driving home after finishing the last of a run of three night shifts at the Norfolk and Norwich university hospital in Norwich.
A police officer who investigated the crash told the inquest into Patel’s death that “the most plausible explanation for the collision was that Dr Patel fell asleep which prevented him from having appropriate control of his car”.
Dr Jyothis Manalayil also died in a crash in June 2022 while driving to an appointment with medical students in Blackpool after working overnight at the Royal Lancaster Infirmary.
Alan Wilson, the coroner who presided at his inquest, said he had not been driving at high speed.
“That gives two possibilities, that he simply was distracted by thinking about something else and at the wrong time lost concentration, or that he fell asleep,” he said.
“We know he is a junior [resident] doctor working long hours and it could have been just fatigue.”
Staff end up fatigued because of long shifts, heavy workloads and a lack of breaks and rest facilities at work, the HSSIB added. But personal issues such as caring responsibilities, menopause, pregnancy and religious practices can also contribute.
“Being a doctor typically involves high intensity, time-pressured working patterns. This can lead to sleep deprivation and fatigue, affecting doctors’ health, wellbeing and performance, their safety and that of their patients,” said Dr Latifa Patel, the chair of the British Medical Association’s representative body and workforce lead.
“The findings of this report are concerning, but will come as no surprise to the doctors who have faced 13-hour back-to-back shifts with no respite.”
NHS trusts and health boards need to do more to improve rest facilities, doctors’ rotas and common room areas, to stop medics getting so exhausted, she added.
“This report lays bare the daily reality for nursing staff. They are overstretched, understaffed and regularly work beyond their hours caring for too many patients,” said Patricia Marquis, the Royal College of Nursing’s executive director for England.
“This drives dangerous levels of fatigue which not only harms patients but also follows staff home, with sometimes devastating consequences.
“Nursing fatigue is deadly and in health and care services should be treated as a public safety emergency.”
A Department of Health and Social Care spokesperson said: “This government inherited a broken NHS with an overworked, demoralised workforce and this report highlights the profound consequences this can have for patients and staff alike.”
They highlighted the pay rises the government gave NHS staff in England and a recent support package intended to improve their working lives, including easier access to flexible working.
