'You're out on a limb, on your own': Social care personal assistants' (PAs') reflections on working in the Covid-19 pandemic - implications for wider health and care services.

Context: In England, Personal Assistants (PAs) are part of an international trend towards state funded but client-hired or directly employed care workers. The Covid-19 pandemic highlighted and exacerbated pre-existing risks and advantages of this arrangement for both PAs and people with care and support needs.

Objectives: We aim to report PAs' reflections on their experiences of working since the pandemic started in 2020 and highlight the longer-term implications for health and care services.

Methods: We undertook a large-scale, qualitative study in 2016-17 involving interviews with 104 PAs about their working lives. We re-interviewed PAs from this group twice to ask how the pandemic had affected them, once at the start of the pandemic in Spring 2020 and again in December 2021 -April 2022. This article reports findings from the last set of interviews undertaken with 38 PAs. Thematic analysis was conducted of interviews in which PAs discussed changes in tasks and responsibilities, pay and conditions, training, relationships and plans.

Findings: This article focuses on the following themes: PAs' perceptions of their outsider status; support and training needs; job security; and whether PAs have an appetite for regulation to provide greater professional standing and connections.

Limitations: Interviews in this study were carried out during the Covid-19 pandemic over the telephone or virtually rather than in person so may have missed certain body language or informal relationship building. The sample may be under-representative of non-British PAs. We were unable to triangulate participants' accounts with others'.

Implications: This study highlights the importance of national and local government including the PA workforce in planning for national emergencies. Consideration should be given by policy makers and local health and care systems to how PAs can be better supported than currently.