Responses from the 7,412 participants fell broadly into two domains, personal and professional. though there was overlap in the content of several themes, with important connections between home working, isolation, and HCW mental health. Furthermore, we found evidence that demographic factors affected the way the respondents reported their experiences of the pandemic, and that experiences also varied depending on the nature of national picture of the pandemic at the time the data was collected. This paper presents qualitative data from the largest UK survey of HCW wellbeing, with demographics broadly representative of the wider NHS workforce ²⁰. It is likely that participants reported the most salient experiences for them, and thus the responses provide insight into important factors that may not have been picked up by other research using pre-defined survey questions or fixed interview schedules.

One, perhaps unsurprising, finding was that the personal challenges most commonly reported by HCWs overlapped considerably with those faced by the general population (e.g. bereavement, social isolation, caring responsibilities). However, we also identified specific workplace challenges for HCWs that are less relevant for many other types of workers (e.g. facing significant risk of infection, redeployment), and these in turn impacted home life. That said, our sample was not homogenous, and variations between participants’ experiences within the workplace suggest that guidance around infection control, vulnerable staff, and redeployment differed between Trusts and teams. This also demonstrates important differences in personal preferences for ways of working, and underlines the challenges for Trusts in offering support that is appropriate for all members of staff.

Some of our findings echo the results of previous quantitative work in this area especially in that increased workloads were a key concern for HCWs ². Many of our participants reported increased workloads, with a vicious cycle of this leading to burnout and sickness absence, which in turn led to further increased workloads for those remaining; this has been noted in other qualitative research ^21,22. As our regression analyses showed, discussion of workplace challenges increased over time, indicating the growing importance of these as the pandemic progressed. However, concerns about heavy workloads would not have been solely due to the pandemic, though it has clearly exacerbated them. The 2018 NHS Staff Survey found that 40% of HCWs reported work-related stress, burnout, and dissatisfaction due to increased workload, which was caused by staff shortages ²³. In our findings and in other research, inconsistency and uncertainty at work are repeatedly mentioned as stressful, and causes of negative wellbeing ^24–27, as were redeployment and changes to working patterns. In contrast, and also found in quantitative studies, peer support and effective leadership help to reduce negative outcomes ^21,26,28.

Lack of PPE was a concern for our participants, and has also been found to negatively impact of employee mental health in non-healthcare settings ²⁹. A number of qualitative studies have found similar results, that access to appropriate PPE is an important factor for HCWs’ mental and physical wellbeing ^26,27,30, though our evidence suggests a temporal trend, with more concerns about this in the early months of the pandemic. There is evidence that access to PPE has been an issue internationally ²⁸ and in previous pandemics ²². Lack of PPE, or access to inadequate PPE, as well as changing guidance about its use, have impacted HCW trust in leaders and politicians, and there have been particular concerns about differential access to PPE, e.g. by women and Black, Asian and minority ethnic HCWs ³⁰.

Fear of infecting loved ones was frequently reported as an important source of stress. This has been reported previously ^21,22, as have the challenges of balancing personal and professional stressors. For example, home working was experienced positively by some, providing time to slow down and connect with family, but others reported this to have been a negative experience, with social isolation, home schooling while trying to work, and physical health impacts all issues of concern ^31,32. These findings were somewhat gendered, with women more likely to discuss home working than men, and this echoes previous qualitative research looking at female HCWs’ experiences of the pandemic ³³.