Many of the country’s hospitals have no rest facilities for doctors and many have inadequate rest areas that require significant modernisation, says the BMA. So, today’s announcement that the Government is to invest £10 million upgrading or installing rest areas or other facilities to improve the lives of junior doctors, is welcome news.
Junior doctors often work long and intense shifts; patient care is being placed at risk if doctors, who are providing round-the-clock care, do not have somewhere to rest. Doctors report having to take a nap in their car, rent a blanket or find a space on the office floor to take a short rest break. The BMA has been told of one hospital trust which has a sign, from the medical director, on a door to a room used by doctors for their breaks, which says that “rest but not sleep” is permitted whilst on shift.
The BMA’s Fatigue and Facilities Charter was published in March 2018. It outlined steps that could be taken to improve facilities. As a result, the Department of Health and Social Care confirmed that it would support doctors with £10 million to improve working conditions in hospitals across the country. The BMA is delighted that the Government has backed this support with tangible investment. Since then Health Education England have been working with the BMA to fairly allocate the funding across the country. All NHS hospital trusts in England will receive £30,000; a total of £6.3 million, with the remaining balance being shared among those hospitals who are in greater needed of investment.
Chair of the BMA East of England regional junior doctors committee and Fatigue and Facilities Charter lead, Dr Rowan Gossedge, spoke about the challenges many doctors face when trying to take adequate breaks. He 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.
"Junior doctors work some of the longest and most intense shifts in a hospital. Overnight they may have responsibility for dozens of very poorly patients and if doctors are not properly rested and focused, they cannot provide the quality of care – safe care – those patients expect and need. Many doctors, finishing long and stressful night shifts often have nowhere to rest or sleep before their commute home, when they will often be driving long distances. That is morally wrong and fundamentally unsafe."
Dr Gossedge goes on:
"We're delighted that, after persistent lobbying from the BMA, all hospital Trusts in England have signed up to our Fatigue and Facilities Charter, and crucially as part of the 2018 contract review, the Government is now providing funding for hospitals to make these improvements. It's incredible the difference that a quiet room, some comfy chairs and beds, or even just a functioning kitchen and dining area, can make to the wellbeing or doctors; after all, a rested doctor is a safe doctor."
Welcoming the investment, the chair of the BMA junior doctors committee, Dr Jeeves Wijesuriya, said:
“This much-needed investment from the Department of Health and Social Care, as an early outcome from the 2018 junior doctors contract review, is extremely welcome and an example of how targeted funding can make a tangible difference to working lives of junior doctors. The BMA has been tirelessly campaigning for improved and more readily available rest facilities and we are pleased to see that the Secretary of State for Health and Social Care has listened to our concerns and responded with positive action. It has been encouraging to see the overwhelmingly supportive response from hospital Trusts, all of whom have now endorsed the BMA’s Fatigue and Facilities Charter, recognising the importance of adequate, free to use rest facilities for staff. Improving the working environment is a key driver in retaining NHS staff. While there is a still a long way to go to alleviating the enormous pressure on juniors and achieving the work/life balance, a commitment of this kind is a significant step which we hope will start to make stories of doctors being injured or worse when driving home after long shifts, a thing of the past.”
Dr Michael McCarron, a paediatrician in emergency medicine, spoke about the facilities at the Sheffield Children's NHS Foundation Trust and how this compares to elsewhere.
“As a first-year doctor 10 years ago, in a different trust, rest facilities were minimal and of extremely poor quality. A rest room was available in the basement of the hospital, with a dirty, sagging sofa and an old TV. Signal for mobile and ‘walkie-talkies’ was poor in the room, which limited communication with the team when working out of hours and therefore regular use of the room was not practical. Added to this, the room was often closed due to flooding and it smelled of damp as a result. The only alternative was a night office – but this was designed and used as a workspace so did not provide a restful environment.
“At Sheffield Children’s Hospital, the rest facilities include a doctors' mess where junior doctors can meet their friends and peers to eat lunch together. It provides a private space where doctors can talk to their colleagues and support each other. It is a hugely important space for safeguarding the mental health and wellbeing of junior doctors.
“The trust has invested money from the hospital budget to repair and redecorate the rest facilities, as well as purchasing blackout blinds, new beds, bed linen, coffee tables and throws for the sofas. It would be great if all trusts were prepared to make similar investments in their junior doctors, but where this is not the case. The Government funding will ensure that all junior doctors can benefit in the future from rest facilities like those at Sheffield Children's Hospital.”
Dr Caroline Kavanagh, assistant medical director for medical workforce at the Norfolk and Norwich University Hospital Trust said:
“Our hospital is committed to looking after the wellbeing of our junior doctors. They are the workforce of the future. We have experience of the risks for fatigued doctors after night shifts and have made several changes to make facilities better. These include asking our doctors at the morning handover if they are too tired to go home and if they are they can book into a nearby hotel which the trust pays for. We also purchased large recliner chairs and placed them in quiet rooms for night-time naps – these ‘sleepy chairs’ are very much welcomed by the doctors. We are currently also working with our junior doctors committee regarding the redecoration of the doctors mess.”
Notes to editors
The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
• All 210 NHS Hospital Trusts in England will receive £30,000, a total of £6.3 million.
• The remaining balance of £3.7m will be shared equally between 122 Hospital Trusts defined as having a greater need (using data from a range of sources and perspectives).
• In 2019/20, 92 Trusts in England will receive £30,000 for this purpose and the remaining 122 Trusts will receive £60,833
• You can find more about the work the BMA has done on the impact of fatigue and sleep deprivation here.