Work

Beyond expansion: workforce absence, administration and the persistence of NHS elective backlogs

Year: 2026

Type: article

Abstract: OBJECTIVE: To identify and quantify key factors driving the decline in efficiency of NHS elective care, focusing on medical workforce dynamics, resource allocation and systemic inefficiencies. We hypothesised that medical workforce sickness absence and administrative turnover significantly affect productivity and backlog growth, instead medical workforce turnover has not effect. DESIGN: This research is a national retrospective observational study using monthly panel data from NHS Digital (January 2018-December 2023). Ordinary Least Squares regression and Generalised Method of Moments models were applied to estimate the impact of workforce and resource factors on productivity and backlog indicators. These methods will account for the unobserved factors and potential reverse causality problem. SETTING: The study follows secondary care across all NHS Trusts in England, with performance measured at the Trust level. PARTICIPANTS: All NHS Trusts delivering elective surgical services between January 2018 and December 2023. The unit of analysis was Trust-month observations, encompassing all elective surgical patients treated in each Trust. MAIN OUTCOME MEASURES: (1) Average per capita completed surgery elective cases (proxy for productivity). (2) Ratio of incomplete elective surgery to average completed elective surgery cases (proxy for additional resources needed to meet demand). RESULTS: < 0.05). Findings were robust to controls for other workforce and resource-related variables. CONCLUSIONS: Workforce expansion alone will not resolve NHS elective surgery backlogs. Reducing medical sickness absence, enhancing staff wellbeing and ensuring adequate administrative capacity are critical to improving productivity and reducing waiting times.

Source: Journal of the Royal Society of Medicine

DOI: 10.1177/01410768261442040

Authors: Cristina Tealdi, Joan E. Madia, Ahmar Shah, Aziz Sheikh, Catia Nicodemo

Institutions: Heriot-Watt University, University of Oxford, University of Edinburgh, Brunel University of London

Language: English

Topic: Health Services Management and Policy

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Decent work and economic growth

Open Access status: hybrid

Estimated APC paid: $4,400