Healthcare fatigue calculator
Score an NHS rota shift on the HSE fatigue index.
A ward night run, a set of long days, a junior doctor on-call weekend: this healthcare fatigue calculator scores one rota shift on the HSE fatigue and risk index, the general UK method, with up to two prior shifts feeding the cumulative load. Healthcare has no sector standard equivalent to rail's NR/L2/OHS/003, so the form opens on the Working Time Regulations profile and the junior doctor contract limits are set out below as what they are: contract terms, not index thresholds. No signup, nothing stored unless you save.
An independent implementation of HSE Research Report RR446. Not an HSE, NHS, HSSIB or CQC product. The general calculator covers every profile.
General calculatorThe HSSIB fatigue reportFatigue management for healthcare
One shift is a taster. The rota is the hazard.
Drop the CSV or XLSX your rota tool exports. Every shift is scored in the browser session; nothing is saved until you ask.
Deterministic scoring against HSE RR446 on the Standard WTR profile. Nothing is stored unless you choose to save. The same engine scores whole rotas in RotaPulse, free up to 10 workers.
What the calculator checks, and where the figures come from
The Working Time Regulations are floors, not targets, and they do not score cumulative fatigue. The index does that. Every profile figure below is read from the Standard WTR profile in the engine, the same one the form scores against; the average week needs the whole rota and is checked on upload.
| Check | Figure | What it means |
|---|---|---|
| Average working week | 48 hours | WTR floor, averaged over the reference period. Needs the rota, not one shift. |
| Daily rest between shifts | 11 hours | WTR floor. The calculator measures the rest before this shift against it. |
| Break on a shift over 6 hours | 20 minutes | WTR floor. The break field is checked against it as you type. |
| Shift length flagged by the profile | 12 hours | The general profile's check. The junior doctor contract allows 13 hours, so a long day over this figure is flagged for attention, not as a breach. |
| Fatigue index, elevated from | 22 | The generic band. No healthcare body has published a figure of its own. |
| Fatigue index, high risk from | 40 | The generic band. Comparative, never a pass mark. |
Sources: Working Time Regulations 1998; HSE Research Report RR446. The fatigue index bands are the general ones RotaPulse applies under this profile. No healthcare regulator has published an index figure, and this page does not pretend otherwise.
Worked healthcare examples
Each link loads the shift into the calculator above and scores it. Then change one thing: drop a prior shift, lengthen the break, move the start.
Fourth long day on the ward
A 12-hour ward shift, 07:30 to 19:30, with the third and second long days before it on the same times and a 30-minute break. Four long days in a row is a common nursing pattern; the cumulative driver is what climbs.
Load this shift into the calculatorThird night of a ward night run
A night shift from 19:30 to 08:00, with the two nights before it on the same times. The index penalises night work on its own; the short daytime sleep between nights is what the cumulative component adds.
Load this shift into the calculatorJunior doctor: Saturday on call after a long day
A Saturday on-call shift, 08:00 to 20:00, after a Friday long day on the same hours and a Thursday before it. Tag it on call and the job type stays concentration. The contract permits the sequence; the index shows what it costs by Saturday evening.
Load this shift into the calculator
Reading a healthcare result
The Fatigue Index is the estimated probability, as a percentage, that a person on this shift will feel very fatigued at some point during it. The Relative Risk is comparative: a relative risk of a fatigue-related error against a reference pattern of 12-hour shifts on a two-day, two-night, four-off cycle. Neither is a verdict on the nurse or the doctor working the shift.
The result names the band as within reference, above reference or high risk, and shows the profile's figures next to the number. The WTR flags in the result are the statutory ones; the band is not. A shift inside the contract and inside the WTR can still sit in the high-risk band, and that is the point of scoring it: the 2019 BMJ Open study that ran this method over foundation doctor rotas found exactly that.
What a single shift cannot show
The average week, the run of consecutive shifts and the rest after a set of nights are rota properties. One shift with two priors shows the rest gap, the break, the length and the two indices; it cannot show the fortnight. The upload under the result scores every shift on the rota with each person's earlier shifts as their priors.
It scores the rota as planned. The swap agreed on the ward WhatsApp, the extra bank shift and the commute after a night are what HSSIB found nobody records. Read what the report asks of providers on the HSSIB page, how the regulations fit together on the healthcare page, and what the index does to a junior doctor rota in the rota post. The method in full is on the methodology page.
Questions
Is there an NHS fatigue risk calculator?
Not an official one. The HSE fatigue and risk index is the general UK method, published in research report RR446, and it is the method a research team used to score junior doctor rotas in a 2019 study. No NHS body, and neither HSSIB nor CQC, has published a calculator or an index threshold for healthcare. This page runs the general method on a ward or junior doctor shift.
Why is there no healthcare profile in the dropdown?
Because there is no healthcare standard to build one from. Network Rail publishes NR/L2/OHS/003 with figures against the index; healthcare has nothing equivalent. Inventing a profile would put a number on the page that no regulator has set. The form opens on the Working Time Regulations profile, which is the legal baseline for every healthcare worker, and the junior doctor contract limits are quoted here as contract limits.
What does the 2016 junior doctor contract limit?
Among other things: no more than 72 hours of work in any seven consecutive days, no shift longer than 13 hours, no more than four consecutive long shifts of over ten hours, and no more than four consecutive night shifts with 46 hours' rest after the run. These are contract terms, not fatigue index thresholds. A rota can meet every one of them and still score high risk on the index.
What did HSSIB find about fatigue in the NHS?
Its 2024 investigation concluded that staff fatigue is a significant and under-recognised patient safety risk, that around four in ten acute hospital staff report feeling worn out at the end of a shift always or often, and that fatigue is rarely captured in incident reports, so organisations cannot show it is under control. Scoring the rota is one way to have that evidence before an inspector asks.
Is a score below the high-risk band a safe rota?
No. The bands are comparative: within reference, above reference, high risk. There is no pass mark. The index models a statistical average person on the pattern as planned; it knows nothing about the commute, the second job, the childcare or the sleep actually had. A ward rota that is legal under the WTR and inside the contract can still be one the index flags, and one it does not flag can still be exhausting.
Which fatigue rules apply to the rest of the ward?
The Working Time Regulations 1998 apply to every healthcare worker: the average week, daily rest and the break. CQC Regulation 18 asks providers to show that staffing is safe, which inspectors read to include how fatigue across the rota is managed. Nurses, healthcare assistants and allied health professionals have no contract limits equivalent to the junior doctor ones, so the WTR floors and the index are what there is.
One shift is a taster. The rota is the risk.
RotaPulse scores every shift on a ward or junior doctor rota, flags the risky runs in plain English, proposes the smallest fix and produces a dated PDF you can put in front of a CQC inspector. Free up to 10 workers.
Sources: HSSIB, The impact of staff fatigue on patient safety (2024); Cumber E et al., BMJ Open 2019;9:e023470 (the fatigue and risk index on foundation doctor rotas); CQC Regulation 18 (Health and Social Care Act 2008); the 2016 terms and conditions of service for NHS doctors and dentists in training; Working Time Regulations 1998; HSE Research Report RR446 (Spencer, Robertson and Folkard, 2006). RotaPulse is a TeZe Ltd product. This page is guidance, not a safety certification and not clinical advice.