Observational studyJournal of the Royal Society of Medicine2026
Beyond expansion: workforce absence, administration and the persistence of NHS elective backlogs.
Observational study in Journal of the Royal Society of Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Who is responsible when AI kills?Journal of the Royal Society of Medicine · 2026Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo 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.
designThis 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.
settingThe study follows secondary care across all NHS Trusts in England, with performance measured at the Trust level.
participantsAll 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).
resultsA one-percentage-point increase in NHS medical workforce sickness rates was associated with a 4.4% decrease in average completed elective cases (95% CI -0.0598 to -0.0272,
conclusionsWorkforce 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.
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