NHS surgery backlogs can’t be fixed by hiring alone study warns
Researchers from some of the UK’s leading academic institutions have warned that simply hiring more NHS staff will not be enough to reduce surgery backlogs, in newly published research.
The groundbreaking study has found that historically long backlogs continue to persist due to staff sickness and admin instability, as opposed to workforce size.
The study was carried out by researchers from the University of Oxford, Heriot-Watt University, the University of Edinburgh, and Brunel University of London, finding that that elective surgery waiting lists rose almost threefold from 2.6 million in 2013 to 7.7 million by early 2024. While the list has since fallen from its peak, it remains historically high.¹
"When a doctor is off sick, you don't just lose one person, you lose the operations they would have done, the patients who then stay on the waiting list longer, and the knock-on pressure on colleagues who are still at work. The effects compound across the system."
The research has now been published in the globally respected journal of the Royal Society of Medicine.
Cristina Tealdi, Professor of Economics, at Heriot-Watt University’s Edinburgh Business School said: "When a doctor is off sick, you don't just lose one person, you lose the operations they would have done, the patients who then stay on the waiting list longer, and the knock-on pressure on colleagues who are still at work. The effects compound across the system."
The study analysed monthly data of England NHS Trusts between January 2018 and December 2023. Staff sickness absence had a consistent and significant effect: each one percentage point rise in medical workforce sickness rates was associated with a 4.4 per cent fall in completed elective cases. Sickness rates rose from 4.3 per cent in 2018 to 5.0 per cent in 2023.
Administrative staffing also mattered. Trusts with more stable and better-resourced administrative teams cleared backlogs markedly faster – with greater admin stability associated with backlogs shrinking by 14.4 per cent relative to completed operations.
Professor Catia Nicodemo, a health economist at the University of Oxford's Nuffield Department of Primary Care Health Sciences and Brunel University of London said: “You’d think that more staff should mean more patients treated, but that's not what the data show.
"When doctors are off sick and there aren't enough administrators to schedule operations and process referrals, the system slows down regardless of headcount."
The researchers argue that the people who schedule operations, manage referrals, and coordinate patient flow play a larger role in clearing waiting lists than is commonly recognised.
By contrast, the turnover of doctors joining and leaving Trusts had no significant effect. Trusts serving older populations faced additional pressure. A one percentage point increase in the local share of people aged 70 and over was associated with a 13 per cent decline in completed cases, likely reflecting the greater clinical and administrative complexity involved in treating older patients.
Professor Sir Aziz Sheikh, Head of the Nuffield Department of Primary Care Health Sciences at the University of Oxford said: “Staff sickness absence isn't a sign of a lazy workforce – it's a symptom of a system under immense strain.
“The government's forthcoming Workforce Plan offers a clear moment to act on this evidence – by addressing the working conditions that drive burnout and sickness, and ensuring there are enough administrators to keep hospitals running smoothly."
The findings speak directly to the government's 10 Year Health Plan for England, which explicitly commits to reducing NHS sickness absence rates alongside its broader shifts from hospital to community and from treatment to prevention.²
The 2025 NHS Staff Survey, published in March 2026, suggests the challenge remains urgent: 31.5 per cent of staff reported feeling burned out due to their work, up from 30.3 per cent the previous year, and confidence that employers would act on wellbeing concerns fell.³
With the government's 10 Year Workforce Plan expected later this year, the researchers argue this evidence should inform its priorities.⁴
The authors note that the study is observational, based on Trust-level administrative data, and relates specifically to elective surgery rather than urgent, emergency, or outpatient care. The findings should be interpreted as identifying important associations rather than proving direct cause and effect.
ENDS