Background Changes made by palliative care services in response to the pandemic have been reported by service leaders, describing organisation-level decisions and solutions (Bradshaw, Dunleavy, Walshe, et al., 2021; Dunleavy, Preston, Bajwah, et al., 2021; Oluyase, Hocaoglu, Cripps, et al., [pre-print], 2020). The impact of the pandemic on direct care provision as experienced by multidisciplinary team members has not been explored.

Aims To understand hospice multidisciplinary staff’s views on care provision during COVID-19 and the effect of providing care on staff wellbeing, burnout levels and spiritual health and the consequent influence on workforce sustainability.

Methods A survey of clinical staff in an independent hospice providing adult and paediatric inpatients and lymphoedema, bereavement and day services during the pandemic including validated wellbeing, burnout, and spirituality questions. Qualitative data from the survey was analysed using the Human Learning Systems Framework (Lowe & Plimmer, 2019).

Results 29% of staff completed the survey. Staff’s responses demonstrated that the pandemic had a significant negative effect on their wellbeing with high levels of all domains of burnout whilst spiritual health was less affected. Qualitative analysis revealed human themes including the impact of isolation and visiting restrictions on patients and family whilst staff described their ability to maintain a sense of positivity and purpose despite anxiety and frustration. Learning themes focussed on adapting and learning through adversity. System themes described the barriers to providing holistic care and how these were overcome and the importance of accessible communication and ensuring appropriate assessment including the provision of remote, domiciliary, and ambulatory care.

Conclusions Hospice staff’s psychological wellbeing and expertise in providing holistic care has been tested to the limit during the pandemic, however, they have responded with positivity, producing innovative solutions. Hospice staff’s opinions and support for their wellbeing must be incorporated into current and new care models to ensure they can continue to be empathic carers, patient and family advocates and inspirational innovators (Marie Curie, 2021).