• DHSC invests £10m to improve sleeping facilities for doctors in NHS hospitals
  • Some NHS staff have faced threats of disciplinary action if caught sleeping at work
  • But expert says investment needed for whole workforce

The government will invest almost £10m to improve sleeping facilities for doctors at NHS hospitals amid growing awareness of the impact of fatigue on patient safety.

All NHS trusts in England will receive £30,000 to spend on rest areas for medics, totalling £6.3m. A further £3.7m will be shared equally between 122 hospital sites that have been identified as having greater need, taking their total to more than £60,000.

In 2016, HSJ revealed hundreds of doctors were being actively discouraged from taking rest breaks while working at night, despite evidence this improves patient safety. In some instances, senior nurses were told to tour wards to catch staff sleeping who could then face disciplinary action.

The Care Quality Commission told trusts to comply with decade-old guidance that nurses and doctors should be allowed proper rest during night shifts.

Doctors also raised concerns after a number of road accidents and deaths were thought to have been caused by staff falling asleep on their way home.

Michael Farquhar, a sleep consultant at Evelina London Children’s Hospital whose original survey exposed the issue, told HSJ he welcomed the investment. But he added the issue went beyond junior doctors and investment was needed for all staff.

He said: “This is an important acknowledgement of the shifting emphasis that looking after NHS staff is essential if we are to continue to provide safe, effective, efficient high-quality care to our patients around the clock, in the face of increasing pressure on resources.

“While the focus on junior doctors is welcome, it is important to acknowledge that all NHS staff face the same issues when it comes to rest and breaks.

“In the longer term, ensuring all staff can get the breaks they, and their patients, need will need investment to increase the number of doctors and nurses but this is a great step on the continued path to changing the NHS culture about rest and breaks.”

The British Medical Association, which has campaigned on the issue of fatigue, said many hospitals no longer had rest facilities. It said doctors had reported having to sleep in their cars or on office floors during breaks.

It said it knew of one trust where a sign from the medical director on a door to a break room said “rest not sleep” was permitted while on shift.

These rules are at odds with evidence that a nap of between 20 and 30 minutes reduces incidents of harm to patients.

In 2006, the Royal College of Physicians issued evidence-based guidelines which stated a short nap of between 20 and 45 minutes during the night was essential to tackle fatigue. It warned working at night increased the risk of poor decisions and mistakes.

This was backed up by the Royal College of Nursing in 2012, which issued its own support for nurses working nightshifts and recommended employers support “power napping”.

Fatigue and facilities lead at the BMA, Rowan Gossedge, said: “We know of doctors being charged a few pounds by a hospital, to rent a blanket, before trying to find a quiet chair or space on a floor in an office.

“Others are forced to grab five minutes’ rest in their cars, in a car park where they have had to pay to park, simply because there is nowhere for them to rest, refresh and reflect away from the intense environment of the ward.

“We have been told of some of our junior doctor members being threatened with disciplinary action for taking a rest on a night, others monitored by security staff and then reprimanded, as the room they slept in had cameras. Many trusts have no access to food provision between 7pm and 7am.”

The BMA has worked with the DHSC and Health Education England to allocate the funding agreed as part of a wider review to the controversial junior doctors contract.