Project MH35

CATNAPS: Fighting fatigue in the NHS ambulance workforce

CATNAPS: Co-producing an ambulance trust national fatigue risk management system for improved staff and patient safety

Poor sleep and fatigue are common in acute and emergency health care staff, and the Covid-19 pandemic has left many staff stressed and exhausted. This project will explore how fatigue can be managed in the NHS ambulance workforce, and the best ways staff can be helped to sleep better.


Ambulance services are trying out different ways of working to help staff feel less tired at work and safer on scene, but these actions are often piecemeal and we don’t know whether they are making care and working environments safer. We explored staff perceptions of fatigue management in one ambulance Trust through ARC seed funding, and identified the types of actions that staff were currently taking, what they would like to see done differently by their Trust, and what help they would like with their sleep and wellbeing.

Patient and staff outcomes can be improved through development and implementation of a fatigue risk management system (FRMS), as is done in other safety-critical industries like aviation and transport.  The evidence suggests individual components of a FRMS which may be effective, but we do not yet know about the optimal packaging of these interventions. FRMS adoption in the NHS needs local tailoring and understanding of barriers and facilitators.

The aim is to develop a comprehensive fatigue risk management system for the UK NHS ambulance sector that is acceptable, feasible, and likely to improve patient outcomes and staff wellbeing and experience.

Project aims

We have brought together a team of patients, staff with lived experience, fatigue experts, ambulance service researchers and managers, international expertise, and companies currently working with ambulance services on fatigue management. We aim to develop a new approach to fatigue management for the UK ambulance sector that meets the needs of staff and operations and is most likely to improve patient and staff safety. Our recommendations will include learnings from the current COVID-19 pandemic.

The project objectives are to:

  1. Co-produce an agreed set of evidence-based and emerging components of a FRMS for the UK ambulance sector that are considered feasible and acceptable.
  2. Identify which components of a comprehensive FRMS are in use and why.
  3. Investigate how front-line staff and patients experience current fatigue actions and potential to improve safety culture and reporting.
  4. Development and usability testing of the FRMS and its implementation guide that allows tailoring to organisational and local context and is underpinned by a new theory of change and logic model.

To do this we will:

  • Define the actions ambulance services should be taking to monitor and respond to tired crews, and help staff sleep better. We will do this by learning from what happens in other countries, and in high risk industries in the UK
  • Talk to senior managers, local managers, front-line staff and patients to understand their experiences of current fatigue management actions and how they might impact on safety outcomes
  • Produce and test a guide for ambulance services on how to implement best practice in their setting that matches their needs and risks.

We anticipate the following outcomes:

  • New knowledge on the best strategies that ambulance trusts can use to help staff sleep better and to reduce the risk of being dangerously fatigued at work
  • An understanding of how patient and staff safety might be improved with a system-wide approach to preventing and managing fatigue
  • A plan that can be put into practice that can be flexible enough to meet the different needs of each ambulance trust, giving a means by which we can monitor how much the new plan is costing the services, and how effective it is as reducing fatigue.

Who is involved?

Principal Investigator: Professor Kristy Sanderson, University of East Anglia 

Professor Julia Williams, University of Hertfordshire

Dr Colleen Butler, Health & Safety Executive

Dr Lucy Clark, University of East Anglia

Mrs Sandra James, UEA/OHID

Mr Jeremy Dearling, PPI

Mr Jonathan Rogers, PPI/EEAST