Almost half of NHS consultant surgeons in England are carrying out no more than one planned inpatient operating session a week, as shortages of operating theatres, staff and hospital beds continue to drag down productivity, according to a major new workforce census.
The 2025 UK Surgical Workforce Census, published by the Royal College of Surgeons of England (RCS England), surveyed more than 6,300 members of the surgical workforce and found that more than 80% of consultants now deliver two or fewer elective inpatient operating lists per week. The findings underline the scale of the challenge facing the NHS as it struggles to reduce record waiting lists for planned care.
Theatre access limits surgery
More than two in five consultant surgeons reported being restricted to a single planned inpatient operating session at most each week. Access to operating theatres was identified as the single biggest barrier to increasing activity, with 73% of consultants citing a lack of theatre space. Staffing shortages remain severe, with 59% pointing to a lack of theatre staff, while 48% said bed shortages were preventing operations from going ahead even when theatres were available.
RCS England said the figures show that the NHS does not have a shortage of surgeons willing and able to operate, but a system that lacks the physical capacity and workforce to support them.
Pressure on waiting list pledges
RCS England president Tim Mitchell warned that the constraints revealed by the census make it extremely difficult for the Government to meet its commitments to cut NHS waiting lists without substantial and sustained investment. Writing in The Telegraph, he said surgeons regularly arrive ready to operate but are unable to do so because theatres are unavailable.
He stressed that the problem is not a lack of skill or commitment among surgeons, but a system under intense strain. According to Mitchell, the bottleneck is often access to an operating theatre rather than the surgeon or surgical team themselves.
Surgery relies on fragile system
Mitchell described surgery as a “finely tuned ecosystem” that depends on the availability of anaesthetists, nurses, theatre staff and fully functioning facilities. If any part of that chain is missing, surgery cannot proceed. He added that even when a theatre is ready, operations are frequently cancelled because there is no bed available on the ward for patients after surgery.
Training opportunities under threat
The census also raised concerns about the long-term future of the surgical workforce. Nearly half of surgical trainees said they are worried about insufficient protected theatre time, limiting their ability to gain the experience required to progress safely through training.
RCS leaders warned that reduced training opportunities risk creating further workforce gaps in the coming years, worsening pressure on already overstretched services.
Burnout and retention crisis
Burnout among senior surgeons is widespread, with 38% of consultant respondents saying they had considered leaving the profession within the past year. The college warned that ongoing pressure, repeated cancellations and an inability to deliver timely care are taking a heavy toll on morale across surgical teams.
Winter pressures and strike threat
The findings come as the NHS faces one of its worst flu seasons on record, with hospitals under intense pressure from rising emergency admissions. At the same time, resident doctors have warned of a potential five-day strike starting on December 17 unless members accept a Government offer to expand training places.
Health Secretary Wes Streeting has cautioned that walkouts during the current winter surge could put patient safety at risk, warning that people could die if industrial action goes ahead amid record flu admissions.
Government points to progress
NHS England has pointed to rising day-case surgery productivity and the rollout of 123 dedicated surgical hubs as signs of progress in tackling the elective care backlog. A Department of Health and Social Care spokesperson said the Government is providing record levels of NHS funding and rolling out reforms aimed at increasing capacity and improving efficiency.
Infrastructure and staffing remain core issues
Despite these measures, the Royal College of Surgeons said chronic underinvestment in NHS infrastructure continues to hold back recovery. The college highlighted Lord Darzi’s recent report, which estimated a £37 billion capital shortfall across the NHS, leaving many hospitals with ageing theatres and inadequate facilities.
Persistent staffing shortages across nursing, anaesthetics and theatre support roles are also continuing to delay care for patients awaiting common procedures such as hip replacements, hernia repairs and other planned surgeries.
Call for urgent action
Professor Deborah Eastwood, an RCS council member, said urgent action is needed to expand training posts and guarantee protected theatre time if the NHS is to secure the future of surgical care. Without decisive intervention, she warned, patients will continue to face long waits and the surgical workforce will remain at risk of further attrition.
