NHS SURGEONS ONLY OPERATING ONCE A WEEK IN 'CRUMBLING' HOSPITALS
Almost half of NHS surgeons are only operating once a week as productivity grinds to a halt across swathes of the health service.
Doctors have warned they are coming to work “prepared to operate” but “find themselves unable to step into an operating theatre” because of a lack of space and beds.
An audit of more than 4,000 medics has found that more than eight in 10 consultant surgeons are carrying out two or fewer sessions of planned surgery on inpatients per week.
More than two in five surgeons were doing one session a week at the most, the research by The Royal College of Surgeons found.
The college says it is now “near impossible” for the Government to meet its pledges to bring down waiting lists, without major investment.
It will heap pressure on the Health Secretary to reform the NHS and tackle inefficiency, rather than cave into demands on pay.
Resident doctors are preparing to embark on a five-day strike, as hospitals buckle under pressures from one of the worst flu seasons in NHS history.
The British Medical Association (BMA) is polling members on an offer from Wes Streeting, which would vastly expand the number of training places for doctors.
But the union has refused to call off strikes, which will start on Wednesday, unless members decide on Monday to consider the terms.
Mr Streeting has warned that patients could die if the walkouts go ahead this week, with the NHS already in the “worst case scenario” with record numbers of flu patients.
The BMA has been pushing for a pay rise of 26 per cent, on top of an increase of almost 29 per cent over the past three years.
Tim Mitchell, the president of the RCS of England, said too many hospitals were being left to “crumble”, leaving patients stuck on waiting lists.
Writing for The Telegraph, he said: “Every day across the NHS, surgeons arrive prepared to operate. Yet, far too often, many find themselves unable to step into an operating theatre.
“This isn’t because they lack skill or commitment. It’s because the system they work in is under immense strain and the bottleneck isn’t always the surgeon or another member of the surgical team – it’s access to a theatre.”
He said surgery was a “finely tuned ecosystem” which needs anaesthetists, nurses, theatre staff, as well as functioning facilities for operations to go ahead.
“If even one link in that chain is missing, surgery cannot proceed. And even if an operating theatre is ready to go, surgery cannot happen if there isn’t a bed on the ward for the patient, especially if they need a critical care bed,” he said.
Access to facilities and staff shortages
The college’s research found that lack of access to operating theatres was the key problem, with 73 per cent of consultants saying this was an issue. Meanwhile, 56 per cent blamed theatre staff shortages and 47 per cent cited bed availability.
Separate figures for day cases found that most surgeons did a maximum of one session a week operating on such patients. And a minority of surgeons – less than one in three – also did at least one emergency session per week.
The report also found that, as well as not having enough theatres to meet demand, existing ones were often not available or not fit for use, due to maintenance issues and outdated equipment.
A shortage of theatre staff means that at other times, operations are being cancelled, even when theatres are available, the study found, with the situation compounded by bed shortages.
It follows a national investigation by Lord Darzi, which warned of a £37bn shortfall in capital investment.
The Government has pledged to cut waiting lists, promising to meet targets for planned hospital treatment to start within 18 weeks by the end of this Parliament.
But progress has been set back by poor productivity and repeated strikes, with the fourteenth round of walkouts due to start on Wednesday, unless resident doctors back a new offer which has been put to them in an immediate online vote.
The offer includes emergency legislation to prioritise UK medical graduates for training places, and an extra 4,000 such places, to reduce bottlenecks and ensure doctors can proceed in their careers more quickly.
The census also found that surgical trainees were not getting sufficient time for training, with almost half of them citing this as a concern.
It polled 4,468 medics in total, including consultant surgeons and resident doctors.
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Mr Mitchell said: “Our census paints a stark picture: operating theatre access remains the single biggest obstacle to dealing with the waiting list, compounded by emergency workloads and staffing shortages. Burnout is continuing to drive surgeons to contemplate walking away from the profession altogether.
“When these pressures collide, planned surgery lists are pushed back. For patients waiting months for hip replacements or hernia repairs, this feels like a broken promise. For surgeons, it’s deeply frustrating. Patients deserve better. Surgeons want to do their jobs. We need to give them the tools and the theatres to do so.”
Prof Deborah Eastwood, a council member of the RCS of England, said: “For world-class surgical care tomorrow, we must invest in surgical training today. This can only be done by increasing core and higher surgical training posts to meet patient demand, redistributing posts to under-doctored areas, and targeting bottlenecks in progression.
“Protected time in theatres for resident doctors in surgery to practise their craft is also essential, coupled with a culture that values learning as much as service. Without urgent action, we risk leaving the next generation of surgeons, and their patients, behind.”
Professor Tim Briggs, National Director for Clinical Improvement and Elective Recovery at NHS England, said: “While the NHS has made significant strides on reducing waiting lists, including the first springtime drop for 17 years, we know there is further to go to ensure we are delivering even more for patients.
“The number of day cases – patients who receive their surgery and return home on the same day – and theatre productivity are at the highest level they’ve ever been in the NHS, which is freeing up beds, while more community diagnostic centres and the opening of 123 surgical hubs with dedicated beds and staffing to carry out more procedures are helping drive down waiting times and making better use of NHS resources.”
A Department of Health and Social Care spokesman said: “This government has provided the NHS with record funding, and thanks to our reforms, the health service is delivering record activity and increased productivity.
“Patients deserve to get the surgery they need without lengthy waits, and that’s exactly why this government invested in 17 surgical hubs this year, delivering tens of thousands of extra operations a year.
“Surgical hubs are a key part of the government’s plan to increase capacity for planned surgery and reduce waiting times. The hubs focus entirely on planned procedures so operations can continue without being disrupted by emergency admissions.”
Surgeons are ready, but too many operating theatres are not
by Tim Mitchell
Every day across the NHS, surgeons arrive prepared to operate. Yet, far too often, many find themselves unable to step into an operating theatre.
This isn’t because they lack skill or commitment. It’s because the system they work in is under immense strain and the bottleneck isn’t always the surgeon or another member of the surgical team – it’s access to a theatre.
An operating theatre is more than a room with lights and instruments. It’s a finely tuned ecosystem, requiring anaesthetists, nurses and theatre staff. If even one link in that chain is missing, surgery cannot proceed. And even if an operating theatre is ready to go, surgery cannot happen if there isn’t a bed on the ward for the patient, especially if they need a critical care bed.
Our members across the UK say that this is a deeply worrying and all-too-common problem.
Our new 2025 UK Surgical Workforce Census highlights this yet again – 53 per cent of surgical consultants surveyed stated that theatre access is a critical barrier. This is driven by a lack of theatre space (73 per cent), availability of theatre staff (59 per cent) and bed availability (47 per cent).
Many operating theatres are also in dire need of modernisation. The Government is championing robotic-assisted surgery for its potential to transform patient outcomes and reduce waiting lists, yet most NHS theatres will require major upgrades – from reconfigured layouts and reinforced power supply to enhanced digital infrastructure and redesigned workflows – alongside substantial investment in the robotic systems themselves.
Nearly half of surgical consultants lack access to a surgical hub – critical facilities that keep planned operations running even when hospitals are overwhelmed by emergencies and winter pressures like the surge in flu cases we are currently facing.
We support a modern, sustainable NHS workforce and believe surgical teams can lead in improving care, productivity and innovation.
But any potential is hampered by ageing infrastructure and long-term, systemic underinvestment. Sustained investment is required in NHS buildings and basic IT systems to support training and to create a culture where staff can thrive.
Without urgent investment in theatre infrastructure and surgical staff, the Government’s pledge to restore the 18-week treatment standard by the end of this Parliament risks slipping out of reach.
The recent Estates Return Information Collection data show that the maintenance backlog across NHS buildings in England is now estimated at £15.9bn for the 2024/25 financial year.
The Government’s Autumn Budget allocated £300m capital investment in NHS technology to improve patient services and to support NHS productivity. Funding for 250 new Neighbourhood Health Centres was included in this.
Secondary care cannot be forgotten. This just does not go far enough.
Our census paints a stark picture: operating theatre access remains the single biggest obstacle to dealing with the waiting list, compounded by emergency workloads and staffing shortages.
Burnout is continuing to drive surgeons to contemplate walking away from the profession altogether.
When these pressures collide, planned surgery lists are pushed back. For patients waiting months for hip replacements or hernia repairs, this feels like a broken promise. For surgeons, it’s deeply frustrating.
Patients deserve better. Surgeons want to do their jobs. We need to give them the tools and the theatres to do so.
Tim Mitchell is the president of the Royal College of Surgeons of England
2025-12-13T17:05:38Z
