A new report by England’s NHS safety watchdog has revealed that extreme exhaustion among healthcare workers is putting patients at risk, with fatigue contributing to serious safety incidents across hospitals.
The Health Services Safety Investigations Body (HSSIB) issued a stark warning, stating that fatigue-related errors—including medication mishaps, impaired clinical judgment, and even disrespectful behavior—are becoming increasingly common among NHS staff grappling with long hours and relentless pressures.
Although comprehensive data on the problem remains scarce, the watchdog pointed to staff surveys and testimony from healthcare safety experts that fatigue is a contributing factor in numerous incidents, often with severe consequences. Among the cases cited were mistakes during pregnancy scans and the administration of chemotherapy drugs.
In one incident, both a mother and her baby were harmed after an inaccurate scan result, with the staff member involved blaming overwhelming workload and fatigue.
Another case saw staff administer chemotherapy drugs nearly nine hours into a 12.5-hour shift, following limited sleep and minimal breaks due to staffing shortages. Investigators found fatigue was “likely to have been a factor” in both cases.
Staff frequently reported chronic sleep deprivation, with one doctor admitting: “When it gets to that third day of doing these 12-hour nights, it’s dangerous from 2am onwards… do I have the energy or the brain space or the mental space to even make a life-changing decision for a patient at this point?”
The report also highlighted the dangers fatigue poses to NHS staff themselves, noting several instances of healthcare workers falling asleep at the wheel after exhausting shifts. In some tragic cases, staff have died in road accidents following long hours at work.
Factors contributing to staff exhaustion include shift work, excessive hours, lack of rest breaks, family responsibilities, and financial stress. Yet, the HSSIB says the problem is often viewed within the NHS as a personal wellbeing issue rather than a critical threat to patient safety.
Saskia Fursland, senior safety investigator at HSSIB, urged the health system to reconsider how it approaches staff fatigue. “Fatigue is more than just being tired—it can significantly impair decision-making, motor skills, and alertness,” she said.
“We must move away from viewing fatigue as an individual issue… and instead treat it as a system-level risk that deserves urgent attention.”
Dr. Latifa Patel of the British Medical Association echoed the watchdog’s concerns, saying the findings were “concerning but not surprising.” She emphasized the need for better rota design, improved rest areas, and action to tackle workforce shortages.
In response, an NHS England spokesperson acknowledged the risk of burnout and reiterated the organization’s commitment to staff welfare.
“Staff should always feel confident to report patient safety concerns, including those linked to fatigue,” the spokesperson said, adding that flexible working options and mental health support were being expanded.
The watchdog is now calling on NHS England and the government to develop robust systems for monitoring fatigue and to collaborate with trade unions and healthcare employers in raising awareness and addressing the systemic roots of staff exhaustion.
