Surgeons warn government’s waiting list pledge “near impossible” without investment in operating theatres and surgical staff

The Royal College of Surgeons of England (RCS England) has warned that it will be “near impossible” for the NHS in England to meet the government’s manifesto pledge on waiting times without further investment, particularly in operating theatres and surgical staff, as the results of the latest UK Surgical Workforce Census are published.  

Advancing the Surgical Workforce: 2025 UK Surgical Workforce Censusexposes the realities of delivering surgical care in the NHS across the UK - showing minimal progress since the 2023 census. Access to operating theatres is one of the most significant challenges facing the surgical workforce across the UK. More than half (53%) of surgeons responding to the census identified theatre access as a critical barrier to delivering care, with 73% specifically citing a lack of theatre space.

The problem is multi-faceted, with: 

• Not enough theatres overall to meet growing demand. 

• Existing theatres often unavailable or not fit for use due to maintenance issues, outdated equipment, or being out of commission. 

• A shortage of staff, particularly theatre staff, preventing operations from going ahead when theatres are available. 

• Bed shortages further restricting ability to schedule procedures. 

The surgical workforce, including dental surgeons, is under mounting pressure. Rising levels of burnout among consultants and trainees, and increasing reliance on staff working beyond contracted hours, are creating unsustainable conditions. At the same time, limited access to surgical hubs and a growing risk of attrition among experienced consultants, highlight the urgent need for targeted action to protect the future of surgical services. 

Reflecting on the findings on access to operating theatres, Mr Tim Mitchell, President of the Royal College of Surgeons of England, said: 

“While the government strengthens primary care through its 10-Year Plan, we must not ignore the deteriorating state of secondary care, which in some places is being left to crumble.  

“The census findings make one thing clear: for the NHS in England, meeting the government’s manifesto pledge on waiting times - particularly for patients waiting for surgery - is a near-impossible task without urgent investment.  

“Surgeons recognise the need for NHS reform and are committed to delivering the changes required. However, ambitious targets cannot be met without operating theatres, staff and equipment. Immediate action is needed to expand surgical capacity, invest in estates and tackle the £15.9 billion maintenance backlog.  Otherwise reducing waiting times and ensuring patients receive timely care will remain out of reach.” 

Key findings from the 2025 surgical workforce census include:

• Theatre access remains a critical barrier: 53% of surgical consultants identified this as a major challenge, driven by limited theatre space (73%), theatre staff shortages (59%), and bed availability (47%). 

• Burnout is widespread:61% of surgical consultants and 65% of dental consultants, along with 66% of core surgical trainees and 62% of higher surgical trainees, identified burnout as a major challenge.  

• Working beyond contracted hours is routine: 61% of surgical consultants and 69% of dental consultants regularly work beyond contracted hours. 

• Attrition risk is rising: 59% of surgical consultants aged 55-59 years plan to retire within four years.  

The census also highlights the significant pressures facing surgical training. Almost half (44%) of surgical trainees report not having dedicated time for training.  Access to training opportunities in the independent sector - where NHS care is increasingly delivered - remains inadequate. In the past year, only 10% of core surgical trainees and 7% of higher surgical trainees gained operating experience outside the NHS. 

Professor Deborah Eastwood, Royal College of Surgeons of England Council Lead for Workforce and Training, said: 

“The census paints a picture of a surgical workforce going the extra mile for patients in a very challenging environment. The government’s forthcoming 10 Year Workforce Plan and the next phase of NHS England’s Medical Training Review must deliver concrete changes that make the NHS a more attractive place to train and work.  

“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.” 

Alongside the need for more operating theatres and surgical staff, better utilisation of existing capacity should also be considered.  Surgeons are already carrying out evening and weekend work to reduce the backlog.  This must be matched by long-term investment and not reliant on the goodwill of staff. 

Mr Raiyyan Aftab, President of the Association of Surgeons in Training (ASIT),said: 

“Surgical trainees are motivated, committed, and eager to contribute. But without protected training time, exposure to the independent sector, and dependable access to theatres, they cannot gain essential experience.  

“Surgical trainees are an untapped resource for reducing waiting lists. Failing to support them now will leave the NHS without the surgeons it needs for the future.   

“No training today, no surgeons tomorrow.”   

Alongside calling for the government to increase capital investment so that NHS trusts can repair and improve buildings and infrastructure, and increase surgical capacity, RCS England has also made specific recommendations on workforce and training for the 10 Year Workforce Planand Medical Training Review. 

RCS England’s key asks:

1. Publish transparent workforce numbers 
   Government must commit to clear, evidence-based staffing projections with transparent modelling to enable accountability. 

2. Increase surgical training posts 
   Expand core and higher surgical training posts to meet patient demand and address bottlenecks in career progression. 

3. Guarantee theatre time for training 
   NHS England must ensure resident doctors have protected access to operating theatres, including in surgical hubs and the independent sector. 

4. Embed protected training time in job plans 
   NHS trusts must provide designated, ring-fenced time for teaching and training to safeguard patient safety and skills development. 

5. Support workforce wellbeing 
   NHS trusts should take action to improve the working environment and wellbeing of the NHS workforce, including ensuring rest facilities, hot food provision, and wellbeing support for staff. 

6. Mandate flexible working options 
   Embed genuine flexibility in surgical careers through rota design and job planning to reduce burnout and retain talent. 

ENDS

Notes to editors: 

• UK Surgical Workforce Census — Royal College of Surgeons 

• The government has pledged that by 2029, 92% of patients will begin treatment within 18 weeks of referral. As an interim milestone, the target is for 65% of patients to be treated within 18 weeks by March 2026.  

• The latest NHS consultant-led referral-to-treatment data shows that the total waiting list increased by 6,002 in October 2025, reaching 7.3 million. Analysis reveals the percentage of patients who began treatment within 18 weeks slightly decreased to 61.7%, indicating minimal progress has been made towards achieving the interim target of 65% of patients starting treatment within 18 weeks by March 2026. 170,759 patient pathways were waiting longer than 52 weeks.   

• The latest official data from the NHS Estates Returns Information Collection (ERIC) shows that the maintenance backlog across NHS buildings in England is now estimated at £15.9 billion for the 2024/25 financial year. 

• ‘How Much Time Do Surgeons Spend Operating?’https://academic.oup.com/bjs/article/110/Supplement_7/znad258.593/7254462 ?login=false  

• Data sheets are available on request for Northern Ireland, Scotland and Wales.  

• The Royal College of Surgeons of England provides world-class education, assessment, and development to 30,000 surgeons, dental professionals, and members of the wider surgical and dental care teams, at all stages of their careers. Our vision is to see excellent surgical care for everyone. We do this by setting professional standards, facilitating research and championing the best outcomes for patients.   

• For more information, please contact the RCS England press office: telephone: 020 7869 6053/6054/6060; email: pressoffice@rcseng.ac.uk; out-of-hours media enquiries: 0207 869 6056.