The Health and Social Care Workforce Wellbeing and Coping Study has published its Phase 6 Report and Executive Summary. Researchers found the workforce faces continuing substantial pressure, staff shortages and is finding it difficult to cope. In this post, we summarise our findings.

Prof Jill Manthorpe, Director of the NIHR Policy Research Unit in Health and Social Care Workforce at King’s, is a co-investigator on this collaborative research project, involving also researchers from Queen’s University Belfast and Bath Spa University. The study is led from Ulster University (Dr Paula McFadden is Principal Investigator).(1604 words)

The 6th Phase of this UK-wide multi-disciplinary study explored the impact of providing health and social care in the post-pandemic era from November 2022 until January 2023. The analysis builds upon the findings from five earlier Phases, beginning during May 2020 following the first wave of the COVID-19 pandemic in the UK. We received 14,400 survey responses from social workers, social care workers, nurses, midwives, and allied health professionals. We conducted 18 focus groups with frontline workers, managers, and Human Resource professionals.

The study provides a unique opportunity to gain in-depth understanding of how the pre- and post-pandemic times have impacted on health and social care workers’ working life, as well as effects on their own health and well-being. Our Phase 6 report presents survey findings collected over the six-months from the end of 2022 and up to early 2023. They reflect a difficult time of unprecedented industrial action in the NHS and continuing pressures on health and social care services. During this Phase, life was returning to pre-pandemic norms for most people in society, there were few remaining public restrictions, the use of face masks had generally ceased, although still being recommended in health and social care encounters and settings. Health and social care services were therefore adapting themselves to a post-pandemic time at the same time as still caring directly for people with illnesses related to Covid-19, and delays in seeking healthcare. Other impacts of the pandemic have placed increasing pressures on health and care services, such as sickness absences, staff vacancies, and retention problems, with mental health problems and new conditions such as ‘Long-Covid’, now affecting workforce stability.

Multiple workplace factors are described as a ‘vicious cycle’. For example, increased job-related pressures, exacerbated by staffing shortages and vacancies (increased use of agency or locum staff) add to job stress and this affects staff’s mental health and well-being. Some respondents indicate lasting or new depression and anxiety, or long-standing distress or trauma because of working through the pandemic. While the survey found many staff had made use of employer’s support services, not everyone sees them as accessible or helpful. Investment is still needed here; the report’s authors recommend.

Summary of Key Findings from Phase 6:

Impact of COVID-19 on service pressures at end of 2022/start of 2023

• A tiny minority (2.9%) reported that their service had not been impacted (services stepped down/changed due to COVID-19)
• Over half of all respondents (58.1%) reporting feeling overwhelmed by increased and continued pressures.
• Social workers and social care workers were the most overwhelmed occupational groups in terms of impact measured in this study (68.4% of social workers and 57.1% of social care workers).
• Significant percentages of nurses (47.7%), midwives (39.4%) and allied health professionals (37.0%) also expressed feeling overwhelmed by increased pressures.

Intention to Leave Employer

• Nearly half of the respondents UK-wide (43.0%) had considered changing their employer, with the highest proportion of these being from England (51.5%), closely followed by Northern Ireland (43.3%), Scotland (41.3%) and Wales (31.9%).
• Within social work, 48.9% of respondents considered changing their employer followed by nurses (42.7%), AHPs (42.3%), midwives (41.4%), and social care workers (39.1%).

Intention to Leave Occupation

• Over a third of the respondents UK-wide (39.6%) also had considered changing their occupation with the highest proportion of these being from Scotland (43.4%), followed closely by England (42.0%), Northern Ireland (38.8%), and Wales (27.7%).
• Within social care workers, 44.2% considered changing their occupation during the pandemic, followed closely by midwives (41.4%), nurses (37.6%), within both, social workers and AHPs, 36.2% of respondents considered changing their occupation.

Intention to leave: Lower Quality of Work Life, Higher Burnout, and lower Wellbeing.

• Both mental well-being and quality of working life deteriorated from Phase 1 to Phase 6 of the study.
• Respondents who stated that they were intending to leave their employer and occupation reported lower well-being and work-related quality of life scores and higher burnout scores than those who did not intend to leave their employer or occupation.
• Feelings about a lack of reward is evident in this survey’s responses and reports of seeking new employment suggested a rising rate of resignations and retirement intentions.
• Respondents reporting client-related burnout, suggested that they were no longer feeling that their work with patients or service users was personally rewarding, and were more likely to have considered changing their job.

What have workforce told us about what they need for wellbeing and retention?

The survey findings suggest robust and reliable support systems/services are needed among all health and social care employers to stabilise the workforce, increase retention, and promote wellbeing at work. Positive examples of supportive interventions have included working within capacity, safe workloads, supportive working culture, co-worker support, camaraderie, team support, manager support, and support for managers. The reliance on managers to provide such support requires adequate and sustained support for managers themselves. This was confirmed by our focus group participants who confirmed that the main support people benefit from is each other. Therefore, building teams and support for teams are critically important.

Good Practice Recommendations

Based on the voice of the workforce, these are grouped under three main themes: Changing conditions, Connections and Communication. The full reports from all previous five surveys, including the Executive Summaries with Good Practice Recommendations can be found on our website www.hscworkforcestudy.co.uk.

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Prof Jill Manthorpe, Director of the NIHR Policy Research Unit in Health and Social Care Workforce, comments:

“We thank everyone for taking part in this survey and our discussion groups. Your views have been heard. You have told us of the pressures in health and social care and how they affect your ability to do the jobs you trained to do and want to do well.  You have explained how difficult it is at times to stay well, and to do the best you can for patients and service users. We hope your employers will continue to invest in support for you as individuals but also to change work arrangements so that you can work well and safely. While the pandemic is now thankfully not affecting most of society so severely, it has a substantial legacy in health and care services, that everyone needs to recognise.”

Dr Paula McFadden, Principal Investigator of the study comments:

“This Phase 6 Report marks the third anniversary of COVID-19, and the health and social care workers’ magnanimous response to the shock of pandemic, and all that entailed for them, their service users, families and loved ones. They have shown great resilience in the face of such overwhelming challenges, but it has been with a cost to their own wellbeing. It is time now for employers, and all stakeholders, to take forward the evidence produced in studies such as ours, and use the intelligence provided wisely, to inform authentic supports, interventions, and investment in the workforce. Otherwise, the current workforce crises will continue to get worse with dire consequences for this workforce and society in general.”

Marian O’Rourke, Director of Regulation and Standards, Northern Ireland Social Care Council, comments:

“We at Northern Ireland Social Care Council, are delighted to see the Phase 6 HSC Workforce Wellbeing and Coping Study being launched. This important research is critical to develop both a deeper understanding of workforce pressures and how staff are affected. We as the social work and social care regulatory body, benefit from critical insights, which inform the development of appropriate interventions to respond to these issues in a timely manner. The research provides a comparison between U.K. countries and other health professionals, which has been its strength since launched in 2020.”

Karen Murray, Director of the Northern Ireland Royal College of Midwives comments:

“As we approach the third anniversary since the beginning of COVID-19, we would like to thank the work of the HSC Workforce Wellbeing and Coping Study research team, for providing timely, regular, and detailed analysis on nursing and midwifery data. This has informed our workforce interventions and supports and provided an independent evidence base, that we were able to reach for routinely. The research provided us with local, regional and national evidence, which has provided the workforce with a voice during this unforeseen three-year period.”

The research team included:

• Dr Paula McFadden¹
• Dr John Mallett¹
• Dr Heike Schroder³
• Professor Jermaine Ravalier⁴
• Professor Jill Manthorpe⁵
• Dr Denise Currie³
• Ms Patricia Nicholl³
• Ms Susan McGrory¹
• Dr Jana Ross¹
• Dr Rachel Naylor¹
• Dr Hannah Davies¹
• Dr John Moriarty³
• Dr Justin MacLochlainn¹

¹Ulster University; ²Southern Health and Social Care Trust, ³Queen’s University Belfast; ⁴Bath Spa University; ⁵King’s College London

This publication

McFadden, P., Mallett, J., Schroder, H., Ravalier, J., Manthorpe, J., Currie, D., Nicholl, P., McGrory, S., Ross, J., Naylor, R., Davies, H., Moriarty, J., & MacLochlainn, J. (2023). Health and social care workers’ quality of working life and coping while working during the COVID-19 pandemic: Findings from a UK Survey and Focus Groups Phase 6: 25th November 2022 – 13th January 2023. Belfast: University of Ulster Press. [Executive Summary]

Project page

Other publications from this study are available: Project page at King’s | Home project page at Ulster University

Funding statement

This study is funded by the HSC R&D Division of the Public Health Agency, Northern Ireland (COVID Rapid Response Funding Scheme COM/5603/20), the Northern Ireland Social Care Council (NISCC), and the Southern Health and Social Care Trust, and support from England’s National Institute for Health and Care Research (NIHR) Policy Research Unit in Health and Social Care Workforce – PR-PRU-1217-21002. The views expressed are those of the authors and not necessarily those of the funders, the NIHR or the Department of Health and Social Care.