What Staffing Shortages Mean for the NHS Elective Backlog

The conversation about the NHS waiting lists often misses the most important point. While money, buildings and equipment matter, the biggest limiting factor is people.

Without enough healthcare professionals to deliver care, waiting lists will continue to grow no matter what else we invest in. This reality means we need to completely rethink our approach to the backlog, moving beyond old solutions to new staffing ideas that work in today’s NHS.

Reframing the Elective Recovery Challenge

The NHS faces a staffing reality that we must be honest about. Six million patients now wait for treatment, but our traditional ways of working simply cannot stretch to meet this demand. This isn’t a temporary problem but a deep-rooted challenge requiring completely new thinking.

What if we stopped seeing the backlog as simply “delayed normal service” and instead viewed it as a chance to transform how care is delivered? This new perspective opens up fresh possibilities beyond just working harder in systems that are already broken.

The truth is uncomfortable but necessary: we cannot solve this problem by asking the same workforce to do more. The simple maths of healthcare won’t allow it. Each surgeon, nurse, and healthcare worker can only safely care for so many patients. Our solution must focus on workforce innovation rather than just trying to hire more people.

How Staffing Shortages Affect Elective Care

Staffing shortages impact elective care in several interconnected ways:

Cancelled Operating Lists

One of the most visible effects of staffing shortages is cancelled operating lists. A theatre session requires not just surgeons but anaesthetists, theatre nurses, recovery staff, and various support roles. If any part of this team is unavailable, entire lists may need to be cancelled, potentially affecting 8 to 10 patients in a single day.

These cancellations often happen at short notice when staff are unavailable due to illness, or need to be redeployed to emergency care. For patients who have prepared physically and mentally for surgery, last minute cancellations can be devastating.

Reduced Theatre Efficiency

Even when operations go ahead, staffing shortages can reduce efficiency in theatres. With less experienced staff or incomplete teams, changeover times between procedures often increase, reducing the number of operations that can be performed in a session.

Some complex procedures require specific expertise that may only be available from certain staff members. Without these key people, some operations cannot proceed, leaving valuable theatre time underused despite other staff being available.

Limited Capacity to Add Extra Sessions

The most obvious solution to tackling backlogs is to run additional theatre sessions during evenings and weekends. However, this approach quickly runs into staffing constraints.

The same staff who work during normal hours are often asked to cover these extra sessions. This leads to fatigue, potential burnout, and diminishing returns as tired staff work less efficiently. There is also a finite limit to how much overtime existing staff can reasonably work.

Impact on Patient Preparation and Follow-up

Elective care involves more than just the procedure itself. Patients need pre-operative assessments, tests, and preparation, as well as post-operative care and rehabilitation. Staffing shortages in these areas can create bottlenecks that limit the number of patients who can proceed to surgery.

For example, a lack of pre-operative assessment nurses might mean patients cannot be properly prepared for theatre, while shortages of physiotherapists or district nurses can delay discharge and recovery, ultimately affecting the flow of patients through the system.

The Vicious Cycle of Backlogs and Staffing

A particularly concerning aspect of the current situation is how backlogs and staffing shortages can create a vicious cycle:

Staff Burnout and Turnover

As staff work harder to tackle growing waiting lists, burnout becomes increasingly common. Healthcare professionals facing relentless pressure to work extra shifts and treat more patients often reach a breaking point, leading to sickness absence or decisions to reduce hours or leave altogether.

This increased turnover worsens existing staffing shortages, making it even harder to deliver elective care and causing waiting lists to grow further.

Emergency Care Taking Priority

When staffing is stretched, emergency care inevitably takes priority over elective procedures. Staff regularly get redeployed from planned care to cover emergency departments, acute wards, or critical care units during periods of high demand.

This necessary prioritisation makes perfect sense for individual patients with urgent needs, but collectively it means the elective backlog continues to grow as planned work is repeatedly postponed.

Training New Staff Takes Time

Training new healthcare professionals to fill vacant posts takes years, not months. New medical and nursing students entering training today will not be ready to make a significant impact on staffing levels until several years from now.

This creates a fundamental timing problem. The backlog needs addressing now, but meaningful increases in the workforce will take time to achieve, even with the best recruitment and training initiatives.

Beyond Traditional Workforce Models

The way forward needs bold thinking and a willingness to challenge how things have always been done. Forward-looking Trusts are already trying new approaches that could transform waiting list recovery:

Surgical Hubs and Protected Elective Capacity

Some regions are establishing dedicated elective care centres or surgical hubs with ring-fenced staff who cannot be redeployed to emergency care. These provide more reliable capacity for planned procedures, reducing the risk of last minute cancellations.

By concentrating elective work in specific locations with dedicated teams, these hubs can also achieve greater efficiency and higher throughput than traditional mixed emergency and elective sites.

Skill Mix Changes and Role Evolution

Another promising approach involves rethinking who does what within clinical teams. By training advanced clinical practitioners, surgical care practitioners, and enhanced recovery nurses, Trusts can ensure more procedures go ahead even when consultant numbers are limited.

These expanded roles allow experienced non-medical staff to take on aspects of care traditionally provided by doctors, increasing the overall capacity of the system without requiring fully qualified medical staff for every task.

Staff Wellbeing and Retention Initiatives

Recognising that keeping existing staff is as important as recruiting new ones, many Trusts are implementing comprehensive wellbeing programmes. These include practical support like better rest facilities and psychological support services, as well as more flexibility in working patterns.

Some organisations are also creating roles specifically designed to be sustainable for staff approaching retirement or considering reducing their hours. These “retention roles” often involve less on-call commitment or emergency work, making it possible for experienced professionals to continue contributing to elective care rather than leaving the NHS entirely.

Digital Solutions and Pathway Redesign

Technology offers ways to use scarce staff time more efficiently. Virtual consultations can allow one clinician to assess more patients in a day, while AI-assisted diagnostics help prioritise cases more effectively.

By redesigning entire care pathways rather than simply trying to do more of the same, Trusts can reduce the staffing needed for each patient journey while maintaining or improving quality.

A Flexible Workforce

The future of NHS staffing won’t be built on traditional employment models. Instead, we need to embrace a more flexible way of thinking about the healthcare workforce. This is perhaps the biggest mindset change needed from NHS leaders:

Collaborative Staff Banks

These enable healthcare professionals to work across multiple organisations without the administrative burden of registering separately with each one. This increases the available workforce for elective recovery work and makes it easier to staff additional sessions when needed.

Targeted Insourcing

Some Trusts are using targeted insourcing to bring in complete teams specifically to tackle backlogs in particular specialties. Unlike traditional outsourcing, these teams often work alongside existing staff, using hospital facilities outside normal working hours to maximise theatre usage.

Workforce Flexibility as a Strength

The old idea of “either permanent staff or agency temps” no longer works for modern healthcare. Forward-thinking leaders now see workforce flexibility as a strength rather than a necessary evil.

By embracing this flexibility and creating systems that support professionals working across multiple settings, Trusts can tap into thousands of clinical hours currently lost to rigid work patterns. This isn’t just a temporary fix but a complete reshaping of how healthcare work is organised.

A Collaborative Workforce

As we rethink NHS staffing for the waiting list challenge, collaborative workforce models stand out as a promising solution. As a collaborative staff bank, our Flexzo Ai platform connects NHS Trusts directly with compliance-ready healthcare professionals nationwide.

Our AI-powered system helps reduce elective waiting lists by quickly matching qualified staff to additional theatre sessions, weekend clinics, and recovery initiatives based on their specific skills.

For healthcare professionals, we offer the flexibility to choose when and where they work, attracting talent that traditional employment models miss.

Our streamlined compliance system eliminates repetitive paperwork, allowing staff to move between organisations and start contributing to patient care faster.

Without agency fees, Trusts make their recovery budgets go further while still offering competitive rates to professionals. This approach also supports surgical hubs and specialist elective centres by making it easier to staff facilities away from major teaching hospitals.