Background The Covid-19 pandemic has imposed unprecedented demands on NHS staff and resources, during which time ambulance staff have been working at consistently high levels of operational pressure. This study explores the impact of prevailing conditions on NHS staff experiences, future employment intentions and key factors in decisions to remain in the NHS or leave.

Methods The study was undertaken in two ambulance trusts using an online survey (n=500) and qualitative interviews (n=20) between April 2021 – December 2021. Two rounds of survey data collection captured information at different time points in the pandemic. Interview participants were sampled purposively to include frontline staff, line managers and senior managers. Survey analysis was undertaken in SPSS and interviews were analysed thematically.

Results The majority of survey respondents were frontline staff: Paramedics (44%); Emergency Medical Technicians (25%) and call-handlers (10%). Mean length of service was 13 years. Compared with prior to the pandemic, staff perceived things were worse in terms of staffing levels (80%), stress (77%), workloads (76%), morale (73%) and their mental health (66%). Key concerns related to abnormally high levels of staff absence, the impact of work on mental and physical health, inadequate time to do the job and making mistakes because of workloads. Almost one-in-five respondents had applied for a non-NHS job in the last six months, including 25% paramedics, and 27% wished to be working elsewhere in 5 years time. The interviews provided complementary detail on experiences and employment intentions, with key issues relating to staffing pressures, work demands and conditions, and burnout.

Conclusion The Covid-19 pandemic has had and continues to have a detrimental effect on workload, morale and both mental and physical health, with implications for staff retention and NHS care delivery. Insights provided by this study are intended to inform approaches to staff retention.