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The announcement of £10 million from the Department of Health to be spent improving facilities for junior doctors in hospitals is welcome. It reflects the increasing understanding that looking after our staff is absolutely essential if we are to continue to deliver safe, effective and efficient patient care in the face of increasing resource challenges.
As demands on our healthcare teams rises, our immediate response is often the selfless one – our breaks and rest are less important than making sure the patient is seen as quickly as possible.
While there are obviously some situations where immediate, rapid attention to care of the patient must be the priority, more often patients are best served by healthcare professionals who have been able to take their statutory periods of rest and breaks – to get that essential recharge that we need to keep us functioning at our best.
We’re all used to snatching moments of “rest” in the course of our normal work – for me as a neonatal SHO many years ago, the classic moment of snatched rest was the 60 seconds stood in front of the gas machine waiting for it to churn out the results for the sick baby I was in the middle of treating – but we also know that the Kit-Kat on the run, the sandwich eaten while simultaneously typing a discharge summary, doesn’t really give us the chance to properly recharge.
We need proper downtime, 30 minutes to properly stop, pause, rest, refuel, recharge, before coming back to our work able to give our patients our best. We see that principle, that regular rest and breaks is essential to safe provision of care, firmly enshrined in other professions – the air traffic controller who isn’t allowed to work longer than 2 hours at a time without a mandatory break for example – but we are less good at recognising the fundamental importance of rest and breaks to safe care in the NHS.
The BMA’s Fatigue and Facilities Charter clearly lays out the principles of why rest and breaks are essential, and makes recommendations as to how Trusts can work towards improving their ability to support junior doctors to achieve them. For many Trusts, this isn’t something that can be done in a single step, and needs a gradual approach to improvement – but that change must start with the recognition of the fundamental importance of looking after our staff to being able to provide our patients with the care that they deserve.
To get good rest, healthcare teams need good facilities. Proper rest needs to be a step removed from the work environment, to give the member of staff the chance to genuinely relax and recharge.
The money being provided by the Department of Health translates to a minimum of £30000 per Trust in England to be spent to specifically improve these facilities so … what should it be spent on?
The absolute key is that every hospital, every site where clinical care is being provided from, has its own unique differences. One of the conditions of how the money is spent is that it must be informed by junior doctors working within the Trust, to make sure that it is spent on what matters to doctors currently working on the ground locally. At least some of this money should be specifically earmarked for local, innovative solutions – open it up to a Dragon’s Den for junior doctors for their best ideas to make working in their hospital better!
A good mess can make a huge difference to staff morale, and provide a space to encourage proper rest and breaks. For hospitals without a mess, this money gives Trusts the opportunity to demonstrate their commitment to the Fatigue and Facilities Charter principles by creating one.
For Trusts where the mess has seen better days, £30000 goes a long way towards renovating and rethinking current spaces, and making them genuinely fit for purpose. In larger Trusts, where geography can make accessing the mess, particularly on night shifts, problematic, the idea of creating “mini-messes” is worth exploring – how to turn smaller spaces into break areas removed from clinical activity but still close enough to be able to return quickly if needed.
One-off sources of funding are usually best suited to investment in physical facilities, however there is potential to use some of the money to pump-prime other strategies to support staff. One brilliant example is the “You Got This!” initiative from the Emergency Department at Bristol Children’s Hospital, led by Dr Dan Magnus. This underscores the importance of staff wellness to good care, and puts in place a programme of activities to support team-building, morale, and to directly support physical and mental health. While this money has been allocated specifically to junior doctors, investing in programmes like “You Got This” also makes clear that one of the things that helps best support junior doctors to safely to do their job well for their patients is to be part of a wider team working to the same principles. Using some of the £30K to launch a You Got This-type programme within a Trust would be a fantastic way to demonstrate that … but would need to be matched by ongoing funding in the longer term from Trusts, demonstrating their commitment to the principles.
Lastly, I’m a sleep doctor. I have long emphasised that asking anyone to work at night is profoundly unphysiological – at 3am, your brain and body are desperately telling you you should be asleep, not awake and providing acute and urgent care. Particularly at night, attention to regular rest and breaks is essential if we are going to mitigate the impact of working against our body clocks, as fatigue exponentially increases. For many people, being able to take short 15-20 minute power naps during night-shift breaks can have a big effect both on how they feel, but how well they are able to recharge to best look after their patients.
Investing properly in resources to make that possible is a major symbolic and practical way for a Trust to demonstrate their understanding and commitment of why acknowledging and managing staff fatigue is so important … so I hope at least some Trusts use this money to invest in innovative solutions like sleep pods, capsule spaces to give staff the space to get a proper power-nap. The symbolism of turning around the old message “if we catch you sleeping on night shift, you’re in BIG trouble” to “we expect you to get appropriate power naps during a normal night shift, because we know it’s better for you, better for patients” is powerful. Sleep pods can be stacked like bunk beds, meaning efficient use can be made of pressured hospital spaces, and for many people can make a huge difference to how they feel when working night shifts.
This money alone is not going to fix all of the problems our doctors, nurses and NHS healthcare professionals face in the current challenging environment. We need a continued emphasis on the fundamental importance of looking after our own staff to be able to provide the care patients deserve, and this is a point which becomes more important, not less, as pressure increases – we know that increased pressure and lack of resources can be a significant factor in burnout and we must work to reduce the risk of harm to our own staff as much as we do to our patients. Ultimately, we need more doctors, more nurses … but any step towards improving working conditions for our brilliant NHS teams is welcome.
Dr Michael Farquhar is a Consultant in Sleep Medicine at Evelina London Children’s Hospital
Find out more about the Fatigue and Facilities Charter