You don't just lose one person, you lose the operations they would have done
Across England's NHS Trusts, a coalition of researchers has quietly dismantled one of healthcare policy's most persistent assumptions: that surgical backlogs are primarily a numbers problem, solved by hiring more hands. What the data reveals instead is a system losing capacity not through shortage of staff, but through the slow erosion of those already present — worn down by burnout, unsupported by overstretched administrators, and unable to sustain the throughput that waiting patients require. The remedy, it seems, lies not in expansion but in restoration.
- Elective surgery waiting lists nearly tripled over a decade, reaching 7.7 million patients — a crisis that hiring drives alone have failed to reverse.
- Every percentage point rise in staff sickness drains 4.4% of completed elective cases, and burnout now afflicts nearly a third of the NHS workforce, with confidence in employer support falling further.
- Administrative teams — the schedulers and coordinators who keep operating theatres moving — are proving as decisive as surgeons themselves, with well-resourced admin linked to 14.4% faster backlog clearance.
- Trusts serving ageing populations face compounding pressure, with each additional percentage point of over-70s in the local community associated with a 13% drop in completed cases.
- The government's forthcoming 10-Year Workforce Plan now faces a sharper question: whether it will address the conditions driving collapse, or simply add more people to a system still hemorrhaging capacity.
A research team spanning Oxford, Edinburgh, Heriot-Watt, and Brunel has challenged the dominant logic of NHS reform: that surgery backlogs can be solved by recruiting more doctors and nurses. Analysing five years of monthly data from NHS Trusts across England, they found the real drivers of the crisis are not workforce size, but workforce fragility — and the administrative infrastructure holding everything together.
The scale of the backlog is not in dispute. Elective waiting lists climbed from 2.6 million patients in 2013 to a peak of 7.7 million in early 2024. What the researchers sought to understand was why. Their answer pointed to sickness rates: each one-percentage-point rise in medical staff absence correlated with a 4.4% fall in completed elective cases. Between 2018 and 2023, sickness rates crept from 4.3% to 5.0% — a modest-seeming shift that, compounded across thousands of operations and dozens of Trusts, represents an enormous loss of capacity. As one economist on the team described it, losing a single doctor means losing not just that person, but every operation they would have performed and every patient left waiting longer as a result.
Equally striking was the role of administrative staff. Trusts with more stable, better-resourced scheduling and coordination teams cleared backlogs 14.4% faster relative to completed operations. Yet the turnover of doctors joining and leaving Trusts had no significant effect. The implication is uncomfortable: hiring more surgeons does little if the system cannot schedule them. The unglamorous work of managing referrals and coordinating patient flow turns out to be load-bearing.
The 2025 NHS Staff Survey, published in early 2026, adds urgency to these findings. Some 31.5% of staff reported burnout — up from 30.3% the previous year — and fewer believed their employers would act on well-being concerns. Researchers are clear that their study identifies associations rather than proven causes, and that its scope is limited to elective surgery. But the message to policymakers is pointed: the government's forthcoming 10-Year Workforce Plan will need to reckon with burnout, administrative stability, and working conditions — not just headcount — if it is to make a meaningful dent in the waiting lists that have come to define the NHS crisis.
A team of researchers from Oxford, Edinburgh, Heriot-Watt, and Brunel has upended a common assumption about the NHS: that hiring more doctors and nurses will solve the surgery backlog crisis. Their findings, published in the Journal of the Royal Society of Medicine, suggest the real culprits are far more mundane—and far harder to fix—than simple understaffing.
The numbers tell a stark story. Elective surgery waiting lists nearly tripled between 2013 and early 2024, climbing from 2.6 million patients to 7.7 million. Though the list has since retreated from that peak, it remains at historically elevated levels. The researchers analyzed five years of monthly data from NHS Trusts across England, from January 2018 through December 2023, searching for what actually drives these backlogs. What they found was not a shortage of bodies, but a system hemorrhaging capacity through sickness and administrative breakdown.
When a doctor calls in sick, the damage ripples outward in ways that simple headcount cannot capture. Each percentage point increase in medical staff sickness rates correlated with a 4.4 percent drop in completed elective cases. Over the study period, sickness rates climbed from 4.3 percent in 2018 to 5.0 percent in 2023—a seemingly small shift that compounds across thousands of operations. Cristina Tealdi, an economist at Heriot-Watt, explained the cascading effect: losing one doctor means losing not just that person, but all the operations they would have performed, all the patients who remain on waiting lists longer, and the mounting pressure on colleagues still working. The system does not absorb the absence; it transmits it forward.
But the research revealed something equally striking about the administrative side. Trusts with more stable, better-resourced administrative teams—the people who schedule operations, manage referrals, coordinate patient flow—cleared backlogs 14.4 percent faster relative to the number of completed operations. These are the schedulers and coordinators, the unglamorous backbone of hospital function. When they are stretched thin or unstable, the entire machinery slows, regardless of how many surgeons are on staff. By contrast, the turnover of doctors joining and leaving Trusts had no significant effect on backlog reduction. Hiring more surgeons, the data suggested, does not solve the problem if the system cannot schedule them properly.
Geography and demography added another layer of complexity. Trusts serving older populations faced steeper headwinds. A one-percentage-point increase in the local share of people aged 70 and over was associated with a 13 percent decline in completed cases, reflecting the greater clinical and administrative complexity of treating elderly patients. The system was not just struggling with capacity; it was struggling with the wrong kind of capacity for the patients it served.
The burnout numbers underscore why sickness rates have climbed. The 2025 NHS Staff Survey, published in March 2026, found that 31.5 percent of staff reported feeling burned out due to their work, up from 30.3 percent the year before. Confidence that employers would act on well-being concerns fell. This is not laziness or malingering; it is a workforce under immense strain. As Aziz Sheikh, head of the Nuffield Department of Primary Care Health Sciences at Oxford, put it, sickness absence is not a sign of a lazy workforce but a symptom of a system under stress. The government's forthcoming 10-Year Workforce Plan offers a moment to act on this evidence—to address the working conditions that drive burnout and to ensure enough administrative staff to keep hospitals running smoothly.
The researchers are careful about their claims. The study is observational, based on Trust-level administrative data, and relates specifically to elective surgery rather than emergency or outpatient care. The findings identify important associations rather than proving direct cause and effect. But the implication is clear: simply expanding the payroll will not fix what is broken. The government's 10-Year Workforce Plan, expected later this year, will need to reckon with a different diagnosis than the one it may have anticipated.
Citas Notables
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 cascading pressure on colleagues who are still at work.— Cristina Tealdi, Professor of Economics at Heriot-Watt University
Staff sickness absence isn't a sign of a lazy workforce—it's a symptom of a system under immense strain.— Professor Sir Aziz Sheikh, University of Oxford
La Conversación del Hearth Otra perspectiva de la historia
So the research says hiring more doctors won't fix the backlog. But doesn't the NHS need more staff?
It's not that simple. The data shows the bottleneck isn't the number of surgeons available—it's whether they're actually able to work, and whether someone can schedule them. When a doctor is sick, you lose not just that person but all the operations they would have done.
But sickness rates only went up from 4.3 to 5.0 percent. That's less than one percentage point. How much damage can that really do?
Each percentage point rise in sickness correlates with a 4.4 percent drop in completed cases. So that half-point increase translates to roughly a 2.2 percent loss in surgical capacity across the system. Multiply that across millions of patients and thousands of operations, and it compounds.
What about the administrative staff? Why does that matter so much?
Because no surgeon can operate if no one has scheduled the operating room, processed the referral, or coordinated the patient's arrival. When those teams are stretched or unstable, the whole system slows down. The research found that administrative stability was associated with backlogs shrinking 14.4 percent faster.
So the government should hire more administrators instead of more doctors?
Not instead of—but alongside. The point is that hiring more surgeons without addressing burnout and administrative capacity won't solve the problem. You're treating the symptom, not the disease.
What's the disease, then?
A system under strain. Thirty-one percent of staff report burnout. That drives sickness absence. That drives waiting lists. You can't hire your way out of that.