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Written by Tristan Hulbert, Vivid.Care. Author of “The Healthcare Professional’s Complete Guide to Specialist Seating Assessments”. Last updated: 3 August 2026.
#EndPJparalysis is a campaign to get hospital patients up, dressed and moving, on the basis that time spent in pyjamas in bed costs older people function they may never get back. It was started by Professor Brian Dolan OBE, alongside the related #Last1000Days campaign, and the annual Summit has been co-hosted with Professor Lynda Holt since 2017. It reached national scale during a 70-day challenge marking the NHS’s 70th anniversary in 2018, and it carries on today as a community and event-led movement rather than a centrally funded programme.
If you want the movement itself rather than our summary of it, go to endpjparalysis.org and last1000days.com.
Professor Brian Dolan OBE started #EndPJparalysis from a simple and rather uncomfortable observation: patients who are kept in nightwear behave like patients, and get treated like patients, long after they’ve stopped needing to be.
The related campaign, #Last1000Days, reframes the whole thing as arithmetic. If somebody aged 85 has roughly a thousand days left, then a ten-day admission is one percent of the time they have. Spent lying down, that isn’t a neutral ten days. That framing has changed practice more than any amount of physiology, because it puts the cost in units that patients, families and staff all understand straight away.
Since 2017 the annual Summit has been co-hosted with Professor Lynda Holt, running as a large-scale online event reaching healthcare staff internationally. Both deserve credit whenever the movement gets described, and both are much better people to hear from directly than us.
In 2018, to mark the 70th anniversary of the NHS, a 70-day challenge invited wards and trusts across the UK to record how many patient days were spent up and dressed rather than in bed. A lot of organisations took part and reported millions of patient days between them.
Two things are worth saying about that. The participation was real, and the culture change on a lot of wards was real. The reported totals were self-reported counts collected during a campaign, so they’re best described as campaign participation data rather than research findings.
The British Geriatrics Society uses “Sit up, get dressed, keep moving” as the clinical version of the same idea. The two work together rather than competing. #EndPJparalysis is the campaign and the community, and the BGS phrasing is the clinical instruction – a good one, because it names three separate actions rather than one vague aspiration.
| Action | What it means in practice | Why it matters |
|---|---|---|
| Sit up | Out of bed and into a chair, or at minimum sitting upright with the head of the bed raised. For a lot of patients this is the only rung available on day one. | Breaks up continuous recumbency, improves lung volumes and swallowing position, and starts rebuilding orthostatic tolerance. |
| Get dressed | Day clothes brought in by family, and proper footwear with backs. Part of the morning routine rather than an optional extra. | Changes what the patient expects, and what everybody walking past the bed expects. Footwear matters for safe transfers too. |
| Keep moving | Something every day, progressed as tolerance allows: bed exercises, sitting out, standing practice, walking. | Kortebein and colleagues (JAMA 2007) measured around 0.95kg of lean leg mass lost over ten days of bed rest in healthy older adults. Activity is what limits that. |
It’s community and event-led rather than centrally funded, and there are advantages and disadvantages to that.
The advantage is that it belongs to the people doing it. Wards run it because they believe in it, not because a target requires it, and that tends to produce better and more durable practice than a mandated programme.
The disadvantage is that without central funding there’s no consistent national data collection, so the movement has never been able to demonstrate its effect at scale in a form that would satisfy a sceptical reviewer. That’s a gap in the evidence rather than a gap in the argument.
Its ideas have been absorbed into national guidance in the meantime. NHS England’s Model discharge pathway (July 2026) asks that reviews from admission focus on preventing hospital-acquired deconditioning, which is the same argument arriving by a different route. See deconditioning and discharge.
Add one line to the admission conversation with the family: please bring in day clothes and shoes with backs. The most common reason patients aren't dressed on day four is that nobody asked on day one. It costs nothing and removes the main practical obstacle.
Morning washing and dressing already involves a transfer. Finish it in a chair rather than back in bed. That turns an existing task into a sit-out without adding a new one, which is why it survives busy shifts when standalone initiatives don't.
A daily count of how many patients are up and dressed, displayed where the team can see it. Movements sustain on visible progress rather than on instruction. Our free sit-out audit tool will do the arithmetic without any sign-up.
If the plan is to get people up and dressed, they need somewhere to sit. A ward that commits to getting patients out of bed and then finds the bedside chair is intolerable after twenty minutes hasn’t created a mobility programme, it’s created a series of documented refusals.
If you want the detail on that, it’s on ward chair specification, which is written so a competitor could meet it, and on sitting out of bed.
A campaign to get hospital patients up, dressed and moving, on the basis that unnecessary time in nightwear and in bed costs patients, particularly older patients, function they may not get back. It was started by Professor Brian Dolan OBE and reached national scale through a 70-day challenge marking the NHS’s 70th anniversary in 2018.
If anything on this page misrepresents the movement or the people who built it, please tell us and we’ll correct it.