A new NHS study suggests surgery backlogs may be driven more by staff absence and operational coordination than overall workforce size.

A new study analysing NHS elective surgery performance suggests that operational stability and workforce coordination may matter more than headline staffing numbers when it comes to reducing waiting lists.

Researchers from the University of Oxford, Heriot-Watt University, the University of Edinburgh and Brunel University of London examined monthly data from 132 English NHS trusts between January 2018 and December 2023. Their findings, published in the Journal of the Royal Society of Medicine, show that elective surgery performance continued to deteriorate even as NHS staffing levels increased by around 250,000 over the same period.

For operational research professionals, the study highlights a familiar systems challenge: increasing capacity does not necessarily improve throughput if operational disruption, variability and coordination problems remain unresolved.

The researchers found that a one percentage point increase in medical workforce sickness absence was associated with a 4.4% reduction in completed elective procedures. During the study period, sickness rates increased from 4.3% to 5.0%. At the same time, trusts with more stable and better-resourced administrative teams were significantly more successful at reducing waiting lists, with stronger administrative continuity linked to waiting lists shrinking by 14.4% relative to completed operations.

The findings point towards the importance of effective operational flow across healthcare systems. While workforce expansion often focuses on increasing clinical headcount, the study suggests that system reliability and coordination may have a greater impact on overall performance than raw staffing numbers alone.

Administrative teams emerged as a particularly important operational component. The researchers argue that staff responsible for scheduling procedures, processing referrals and coordinating patient pathways form part of the infrastructure that keeps theatres and waiting lists functioning efficiently. Disruption within these teams can create bottlenecks that affect throughput across the wider system.

Cristina Tealdi, professor of economics at Heriot-Watt University’s Edinburgh Business School, said the operational impact of sickness absence extends well beyond the individual clinician. According to the university, she noted that when a doctor is absent, the effects are felt across waiting lists, operating schedules and colleagues covering additional pressures.

Catia Nicodemo, health economist at the University of Oxford and Brunel University of London, said the findings challenge assumptions that increasing workforce numbers automatically translates into more patients being treated. The study instead suggests that workforce absence, burnout and limited administrative support can constrain system performance even when staffing levels rise.

The analysis also found that local population age profiles affected operational performance. A one percentage point increase in the proportion of people aged 70 and over was associated with a 13% reduction in completed elective procedures, which the authors said may reflect the greater clinical and administrative complexity associated with treating older populations.

For the OR community, the study reinforces the importance of viewing healthcare performance as a systems problem rather than a simple staffing equation. Elective surgery throughput depends not only on workforce numbers, but on the interaction between absence rates, coordination, scheduling, patient complexity and operational resilience across the wider healthcare system.

The findings arrive as the government’s 10 Year Health Plan for England places increasing focus on reducing NHS sickness absence and improving system productivity. Meanwhile, the 2025 NHS Staff Survey, published in March 2026, reported that 31.5% of staff felt burned out from work, up from 30.3% the previous year.

Professor Sir Aziz Sheikh of Oxford said the results should be understood as evidence of wider operational strain rather than individual staff failings. He said the findings highlight the importance of improving working conditions while ensuring hospitals have the administrative support needed to maintain effective operational flow.

References

https://healthcare-in-europe.com/en/news/hiring-staff-nhs-surgery-backlogs.html

https://www.phc.ox.ac.uk/news/more-nhs-staff-surgery-backlogs-sickness-absence