The BMA Fatigue and Facilities Charter was published on World Sleep Day in March 2018. In May this year the BMA confirmed that all NHS hospital Trusts in England have now signed up to this Charter.
However, when HEFMA’s National Secretary, Alison McCree (Managing Director of Synchronicity Care, a wholly owned subsidiary of County Durham and Darlington NHS Foundation Trust) presented the details of the BMA charter to delegates at the recent Forum, a show of hands in the room revealed that very few of the Estates and Facilities professionals present were aware of it and even fewer had started to take steps to implement it at their hospitals.
What is the Charter?
Essentially, this Charter provides simple steps to improve facilities for doctors, particularly junior doctors, who may be working long and intense shifts. The BMA says that many of England’s hospitals have no rest facilities for doctors or inadequate rest areas that require significant modernisation. The BMA further states that doctors have reported 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.
Dr Rowan Gossedge is Chair of the BMA East of England regional doctors’ committee and lead for the Fatigue and Facilities Charter. He says: "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."
There are several different elements to the Charter – some of which are concerned with how shifts are managed and structured as well as providing advice to doctors about healthy lifestyles and the importance of rest. Other elements are concerned with the provision of facilities, including a common room (or ‘mess’), rest facilities, car parking and catering.
What is included in the Charter?
The following elements impact on Estates & Facilities:
Common room or ‘mess’
• Provide an easily accessible mess with appropriate rest areas 24 hours a day, seven days a week, allowing staff to nap during breaks.
• Ensure nap/rest areas are separate from food preparation or routine breaks areas, and that the mess is not used for organised shift handovers or other clinical work – it should be an area of rest and not a clinical environment.
• Provide these areas on site for staff (not necessarily junior doctors), wherever is most appropriate: Lounge (with power points, telephone connection and TV Arial); Office/study area (with power points, telephone connection and internet access); Kitchen (with sink, hotplate, microwave, toaster, fridge, freezer, kettle, coffee machine and supply of tea coffee, milk and bread; Changing facilities and showers; Storage area including lockers for Doctors; Secure cycle storage.
Catering facility
• Must be open 365 days a year.
• Must provide adequate, varied, efficiently served and freshly prepared meals.
• Must offer healthy eating and vegetarian options, and options for a range of cultural and dietary requirements.
• Must serve hot food for extended mealtimes for breakfast, lunch and dinner, where possible with a minimum late opening until 11pm and a further two hour period between 11pm and 7am.
• Must make hot food available if the canteen is closed, through a supply of microwave meals or a similar arrangement. Supplies should be sufficient for all staff on duty, readily accessible to doctors in training, and regularly restocked. Offer card payment or change machines where necessary.
Travel
• Provide sufficient parking, with a short and safe route to and from the hospital, and reserved spaces for doctors expected to travel after dark. This includes those who are non-resident and on-call overnight.
Refer to each department’s rotas to calculate the number of spaces required.
• Where possible, provide an appropriate sleep facility for doctors advising that they feel unable to travel home after a night shift or a long, late shift due to tiredness.
• Where this is not possible, ensure that alternative arrangements are made for the doctor’s safe travel home.
Rest facilities for doctors working on-call, with sleep facilities – individual rooms - available free of charge for all staff who are rostered or are voluntarily resident on-call at night.
• A bed, of good quality, with linen changes every three days and for every new occupant.
• An independently controlled source of heating.
• Towels, changed daily and for every new occupant.
• A telephone with access to hospital switchboard.
• Electrical power points.
• Adequate sound - and light-proofing to allow good quality sleep day and night.
Who will pay for it?
The Government has confirmed it will provide some investment for this initiative to improve working conditions across the country. The BMA reports it is working with Health Education England to allocate the £10m funding fairly across the country. It says all hospital Trusts in England will receive £30,000, with the remaining money being shared amongst those in greater need of investment. In 2019/20 this means 92 Trusts will receive £30,000 with the remaining 122 receiving £60,833.
There was widespread support for the initiative from those at the Forum, although it was felt this should be more inclusive than available only for doctors. There is also clearly an issue with how the information around this Charter and what it involves is being communicated within Trusts and cascaded down from the top to those responsible for implementing changes.
