NHS CHECK: Understanding the mental health and wellbeing of all NHS staff during the pandemic

NHS CHECK is a major study of the impact of the COVID-19 pandemic on the short and long-term health and wellbeing of all staff working within 18 partner NHS Trusts. NIHR ARC North Thames is the lead ARC on this project, working in collaboration with seven other ARCs across the country, including ARC West.

The study is exploring the various support programmes that staff may have taken part in to see how helpful they were, and whether there is other support that could be valuable. This information is important to identify what has and has not worked.

The researchers will use the findings to create better support for NHS staff as well as exploring how to mitigate ethical dilemmas and moral injury of staff, caused by changes in working conditions because of the pandemic.

In March 2020, King’s College London launched rapid response funding call, ‘King’s COVID-19 Response’, to address the very real challenges and hardships caused by the ongoing COVID-19 outbreak across the globe. This study is one of six projects led by the Institute of Psychiatry, Psychology & Neuroscience that was awarded funding as part of the King’s COVID-19 Response.

During the COVID-19 pandemic, many NHS staff will have to make difficult choices they have not faced before, to deliver care which they know is suboptimal and explain this to relatives. These ethical dilemmas will be new and will likely result in some staff experiencing ‘moral injury’.

Moral injury is a relatively new concept but is relevant to the COVID-19 outbreak. Originating in the military, moral injury describes the psychological distress resulting from actions, or the lack of them, which violate someone’s moral or ethical code. The experience of ethical dilemmas resulting in moral injury can lead to negative thoughts about oneself, others and intense feelings of shame, guilt, anger or disgust. These feelings may eventually lead to the development of mental health problems, such as depression, anxiety or post-traumatic stress disorder (PTSD).

The project will explore how a range of individual factors may influence the experience of moral injury in staff, examining everything from professional culture, organisational preparation, team leadership, quality and honesty of staff briefings, and formal training and interventions.

Project aims

The aim of the study is to identify which support programmes have been helpful to NHS staff, which have not been helpful, and whether there is other support that could be valuable. The researchers will use these findings to create better support for NHS staff both now and in the future.

What we did

The research consisted of the UK’s largest NHS survey of the mental health and wellbeing of staff, including clinical and non-clinical. Over 26,000 people have already responded. The researchers are exploring emerging findings and potential actions that could be taken to better support staff.

ARC West supported two trusts in their area, Avon and Wiltshire Mental Health Partnership NHS Trust and Gloucestershire Hospitals NHS Foundation Trust, to recruit a wide range of their staff to take part in the study.

Staff from ARC West and the University of Bristol are leading the analysis of data on the prevalence and incidence of self-harming behaviour among this large cohort of NHS staff.

What we found and what this means

Results from the study so far suggest substantial mental health challenges for many NHS staff during the pandemic, including:

  • Over half (51 per cent) of staff met criteria for probable common mental health disorders
  • Over a third (36 per cent) of staff met criteria for probable PTSD
  • Nearly one fifth (18 per cent) of staff met criteria for alcohol misuse

Given the potential pressure associated with major organisational change across the NHS, results show it will be important to support staff recovery alongside service recovery. Different groups of staff may be affected by the pandemic in different ways, and there may also be differences in their ability to access support.

Leadership at all levels, but especially by those in frontline supervisor roles, has an important impact on staff mental health and in creating a supportive working culture within the NHS. Particularly effective interventions are often informal, easy to access and draw on the potential of teams (rather than mental health professionals) as key sources of support and involve clear and consistent communication. Implementation of these interventions should be tailored to the needs of local staff.

Read more about the findings here

What next?

The research is already starting to have an impact. It has been included in government reports and shared widely with other researchers working in healthcare. This work has provided briefing notes to NHS England and NHS Involvement (NHSE/I) and the House of Lords about the impact of the pandemic on NHS workers’ mental health and wellbeing. NHS England has already announced it will expand mental health support for NHS staff.

Future research findings will be shared with NHS staff via the participating NHS Trust, and with other NHS Trusts nationally via networks and professional bodies. The findings will be published in academic journals, and presented at conferences and meetings with those involved in staff health and wellbeing for the NHS. Summaries will be included on the NHS CHECK website and released to media.

Lead collaborators

  • Professor Sir Simon Wessely, NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London

ARC West Staff

Liz Hill

Liz Hill

Research Portfolio Manager

Partners on this project

Avon and Wiltshire Mental Health Partnership NHS Trust

Avon and Wiltshire Mental Health Partnership NHS Trust provides services for people with mental health needs, drug or alcohol dependency and people with learning disabilities. It covers Bath and North East Somerset, Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire and provides a specialist service throughout the South West.

Gloucestershire Hospitals NHS Foundation Trust

The Gloucestershire Hospitals NHS Foundation Trust is one of the largest hospital trusts in the country and provides high quality acute elective and specialist care for a population of more than 612,000 people. Its hospitals are district general hospitals with a great tradition of providing high quality hospital services. It was one of the UK's first foundation trusts.

University of Bristol

The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.