{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:44:28Z","timestamp":1782729868690,"version":"3.54.5"},"reference-count":20,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health Services and Delivery Research Programme","doi-asserted-by":"publisher","award":["NIHR154061"],"award-info":[{"award-number":["NIHR154061"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J R Soc Med"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This research is a national retrospective observational study using monthly panel data from NHS Digital (January 2018\u2013December 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>The study follows secondary care across all NHS Trusts in England, with performance measured at the Trust level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures:<\/jats:title>\n                    <jats:p>(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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A one-percentage-point increase in NHS medical workforce sickness rates was associated with a 4.4% decrease in average completed elective cases (95% CI \u22120.0598 to \u22120.0272,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Gains in administrative staff reduced excess elective surgery incomplete cases by 14.4% (95% CI \u22120.155 to \u22120.133,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Findings were robust to controls for other workforce and resource-related variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/01410768261442040","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:16:26Z","timestamp":1776831386000},"page":"131-140","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond expansion: workforce absence, administration and the persistence of NHS elective backlogs"],"prefix":"10.1177","volume":"119","author":[{"given":"Cristina","family":"Tealdi","sequence":"first","affiliation":[{"name":"Department of Economics, Heriot-Watt University, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8398-8859","authenticated-orcid":false,"given":"Joan E.","family":"Madia","sequence":"additional","affiliation":[{"name":"Department of Primary Care Health Sciences, Medical School, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5672-0443","authenticated-orcid":false,"given":"Ahmar","family":"Shah","sequence":"additional","affiliation":[{"name":"University of Edinburgh, Usher Institute, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Sheikh","sequence":"additional","affiliation":[{"name":"Department of Primary Care Health Sciences, Medical School, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5490-9576","authenticated-orcid":false,"given":"Catia","family":"Nicodemo","sequence":"additional","affiliation":[{"name":"Department of Primary Care Health Sciences, Medical School, University of Oxford, Oxford, UK"},{"name":"Brunel University of London, Middlesex, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"NHS England. NHS productivity [Public Board paper BM\/24\/19(Pu)]. See https:\/\/www.england.nhs.uk\/long-read\/nhs-productivity\/ (2024 accessed 15 April 2026)."},{"key":"e_1_3_4_3_2","unstructured":"NHS England. NHS waiting list hits two-year low as staff work to turn the tide. See https:\/\/www.england.nhs.uk\/2025\/06\/nhs-waiting-list-hits-two-year-low-as-staff-work-to-turn-the-tide (2025) (last checked 10 June 2025)."},{"key":"e_1_3_4_4_2","first-page":"196","volume-title":"Productivity of the English national health service: 2021\/22 update","author":"Arabadzhyan A","unstructured":"Arabadzhyan A, Castelli A, Gaughan J, Chalkley M. Productivity of the English national health service: 2021\/22 update. Centre for Health Economics, University of York, 2022: 196."},{"key":"e_1_3_4_5_2","unstructured":"The King\u2019s Fund. Productivity in the NHS and health care sector See https:\/\/www.kingsfund.org.uk\/insight-and-analysis\/data-and-charts\/productivity-nhs-health-care-sector (2024 accessed 15 April 2026)."},{"key":"e_1_3_4_6_2","unstructured":"The Health Foundation. The NHS maintenance backlog: rising costs and falling investment. See https:\/\/www.health.org.uk\/reports-and-analysis\/reports\/the-unsustainable-is-not-sustained (2024 accessed 15 April 2026)."},{"key":"e_1_3_4_7_2","unstructured":"Coyle D. The unsustainable is not sustained: Why productivity is fundamental to the future of the NHS. The Health Foundation REAL Centre. www.health.org.uk\/publications\/the-unsustainable-is-not-sustained-productivity-future-NHS (2024 accessed 15 April 2026)."},{"key":"e_1_3_4_8_2","unstructured":"NHS England. NHS England annual report | accounts 2022 to 2023. 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See https:\/\/www.nhsstaffsurveys.com\/results\/national-results\/ (2023 accessed 15 April 2026)."},{"key":"e_1_3_4_12_2","first-page":"151","article-title":"Evaluating the impact of NHS strikes on patient flow through emergency departments","volume":"43","author":"Garner A","year":"2024","unstructured":"Garner A, Ashcroft Q, Kirkwood D, Chandrabalan V, Emsley H, Mason SM, et al. Evaluating the impact of NHS strikes on patient flow through emergency departments. medRxiv 2024; 43: 151\u2013157.","journal-title":"medRxiv"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.3846\/1648715X.2015.1029562"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1108\/BEPAM-09-2015-0055"},{"key":"e_1_3_4_15_2","unstructured":"NHS England. Referral to treatment (RTT) waiting times; 2023. Monthly trust-level dataset 2017\u20132023. See https:\/\/www.england.nhs.Uk\/statistics\/statistical-work-areas\/rtt-waiting-times\/ (last checked December 2023)."},{"key":"e_1_3_4_16_2","unstructured":"NHS Digital. NHS sickness absence rates; 2023. Monthly Trust-level dataset 2017\u20132023. See https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/nhs-sickness-absence-rates (last checked December 2023)."},{"key":"e_1_3_4_17_2","unstructured":"Office for National Statistics. Population estimates for the UK England and Wales; 2023. Mid-year population estimates by local area 2017\u20132023. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates (last checked December 2023)."},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b3264"},{"key":"e_1_3_4_19_2","volume-title":"Strategies to reduce waiting times for elective care","author":"Blythe N","year":"2022","unstructured":"Blythe N, Ross S. Strategies to reduce waiting times for elective care. London: King\u2019s Fund, 2022."},{"key":"e_1_3_4_20_2","unstructured":"Dunn P Ewbank L Alderwick H. Nine major challenges facing health and care in England. London: The Health Foundation 2023."},{"key":"e_1_3_4_21_2","unstructured":"Rimmer AM. Learning journals and the reflective journey to employment. New York: Teachers College Columbia University 2024."}],"container-title":["Journal of the Royal Society of Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/01410768261442040","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/01410768261442040","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/01410768261442040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T09:49:01Z","timestamp":1782726541000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/01410768261442040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/01410768261442040"],"URL":"https:\/\/doi.org\/10.1177\/01410768261442040","relation":{},"ISSN":["0141-0768","1758-1095"],"issn-type":[{"value":"0141-0768","type":"print"},{"value":"1758-1095","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}