Understanding and mitigating the psychosocial impact of the COVID-19 pandemic on NHS staff in England

Lead Research Organisation: King's College London


We will investigate the impact of the COVID-19 pandemic on the psychological health and wellbeing of NHS staff in England. We plan to do this by using a combination of online questionnaires and, with a smaller group of participants, more detailed telephone interviews. Participants will complete questionnaires about their health, distress, and work environment at baseline, four and
eight months later. Having already piloted our processes, we now want to involve additional participants from more NHS Trusts, follow them up over time to see whether their mental health improves or worsens, and to identify which groups of staff may need tailored support.
Our questionnaire has been produced alongside healthcare staff in our local NHS Trusts - but we know we need wider participant involvement. We will form a study steering panel consisting of representatives whose support we have already gained (e.g unions, employers, and different staff groups) and who have enthusiastically collaborated with the pilot study. We will feedback emerging results to participating Trusts, networks, our partners, and NHS England, from which we have full encouragement, to help them prepare for future psychological health and workforce planning needs.

Technical Summary

The nation has relied heavily on NHS healthcare workers (HCWs) during the COVID-19 pandemic and an effective workforce requires good mental health. Poor quality surveys report high levels of distress in HCWs unconfirmed by some population based studies. So robust evidence is still lacking on the size and impact of the pandemic on HCWs, who is at risk, and what support they may require, if any.
We will investigate the psychosocial and occupational outcomes of the pandemic on NHS staff in England, using a well-defined sampling frame across 18 Trusts. Our pilot study, already conducted in three Trusts (Guy's and St Thomas', King's College Hospital, and South London and Maudsley NHS Foundation Trusts) has demonstrated feasibility and acceptability of a brief baseline questionnaire. The original sample will be followed four and eight months later, with 15 new centres contributing data at these timepoints. Questionnaire data will be validated through standardised diagnostic interviews administered by telephone in a sub-sample, to distinguish distress from disorder. Additionally, we will address the use and outcomes of staff support/wellbeing, and a UKRI-funded ethnicity-focused module will capture inequalities in mental health and occupational outcomes. PPI/E will be central: we will establish a steering PPI/E group of NHS workers, unions, and employers, ensuring strong representation of BAME staff. Findings will inform an effective support strategy for NHS staff during and following the pandemic, for example through workforce planning, emergency response strategies, or targeted support. The project team and partners have extensive networks in policy and practice, including NHS-E, allowing for rapid dissemination of findings.


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Description Surveys:
Preliminary data collected by self-report/screening tools show that NHS staff report high levels of symptoms of Post-Traumatic Stress Disorder (PTSD) (up to 26% of staff reporting PTSD symptoms) measured with the 6 item Post-Traumatic Stress Disorder checklist (PCL-6) and a much higher rate of poor general psychological health (56%) compared to the UK general population (27%) measured with the 12-item General Health Questionnaire (GHQ-12).

Diagnostic interviews
We have carried out all (n=337) our planned diagnostic interviews for common mental disorders (CMDs) using the Clinical Interview Schedule-Revised (CIS-R) assessment tool and the Clinician Administered PTSD Scale (CAPS-5) for the DSM-5) for PTSD. As we anticipated, screening tools substantially overestimate the prevalence of mental disorders. Diagnosable disorders appear less prevalent than quantitative screening questionnaires suggest, and diagnostic interviews provide a more accurate prevalence estimate. For example, from our preliminary interview data, around one in 10 fulfil diagnostic criteria for PTSD based on the diagnostic interview data, compared to one in 3 or one in 4 in our questionnaire surveys.

Staff support interviews
Our qualitative interview study focuses on staff experiences of national and local support offerings, interviewing (n=48) clinical and non-clinical staff who have and have not used support services, with results showing that staff are generally satisfied with the range of services provided but awareness and therefore use of national support offerings, such as wellbeing apps and phonelines, is low. However, there are often barriers to accessing services, and access is strongly influenced by line managers' awareness of and attitude towards these services. Staff are aware of and more likely to make use of services that existed prior to the COVID-19 pandemic, as opposed to services set up in response to COVID-19.

Other key findings also emphasise the importance of trust and confidence in line managers. Where staff feel that their immediate supervisor is supportive, which is in the majority of cases, outcomes are better than when they do not. However, it is notable that 6% of staff do not feel at all supported by their immediate supervisor, and 12% feel only a little bit supported, which is a potential concern.
Exploitation Route We have already begun the process of feeding into national NHS policy via Policy Lab sessions, which representatives from NHS E/I attended.
NHS CHECK has already helped individual NHS Trusts in identifying perceived lack of PPE availability, provided data to assist with obtaining funding to contribute towards staff wellbeing, and given a voice to all staff about their wellbeing needs. We have also identified that the relatively novel concept of moral injury [the strong emotional reactions which follow events which clash with one's moral code] is highly relevant in NHS staff; NHS staff who have the highest exposure to potentially morally injurious events are at highest risk of reporting poor mental health.

NHS CHECK findings have been disseminated widely via our extensive network of stakeholders such as NHS E/I, Integrated Care Systems (ICSs) regional wellbeing hubs, Minister of State for Mental Health, Suicide Prevention and Patient Safety, Minister of State for Social Care and NHS Workforce), the various Royal Colleges (e.g. Emergency Medicine, General Practitioners, Nursing, Psychiatrists) and National Clinical Director for Mental Health and informed various policy briefings and guidance such as the Nice Wellbeing at Work Guidance Development Group and the London Critical Care Wellbeing Meeting. We hosted an open webinar where we discussed study findings (https://nhscheck.org/study-findings/). We have also held two policy lab sessions and are in the process of disseminating findings to stakeholders locally and nationally. Results from the study so far suggest substantial mental health challenges for many NHS staff during the pandemic.
Sectors Healthcare

Description Monthly advisory group meetings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Study participants or study members
Results and Impact We have held monthly advisory group meetings with NHS members of staff to receive feedback and suggestions on the study and its next phases
Year(s) Of Engagement Activity 2020