Tackling Surgical Backlogs for Enhanced Patient Outcomes in the NHS

Patient leaves hospital room

Learn more about how J&J MedTech Services & Solutions can help you streamline processes and implement best practices to maximise bed capacity and improve patient flow


The NHS has for many years served as the cornerstone of the United Kingdom's healthcare system, delivering vital medical services to millions and safeguarding the nation's health. However, the NHS faces a mounting crisis that urgently needs addressing: the overwhelming backlog of surgical procedures. This backlog has been exacerbated by a combination of factors, including the devastating impact of the COVID-19 pandemic, which has led to a significant number of delays in surgeries.1 At the end of December 2021, almost 7.7 million people were waiting to have an operation, the highest number since records began in August 2007.2 The result is a two-fold problem: compromised patient outcomes and strained operational efficiency, both of which threaten the long-term viability of the NHS.

While we acknowledge that additional resources are essential to address the surgical backlogs and capacity challenges in the NHS, there are optimisation strategies that can be implemented within the existing model and resource constraints. The J&J MedTech strategy is to embed value solutions in the form of healthcare transformation experts. These specialists will be placed into your organisations with the aim of analysing areas where resource can be best spent and efficiencies saved. Although these measures won’t completely resolve the issue, they aim to significantly contribute to improving patient outcomes and operational efficiency.

A Multi-Year Strategy for Sustainable Solutions
Addressing the surgical backlog in the NHS is a multi-year challenge that requires a nuanced approach focusing on clinical need rather than solely on the numbers on the waiting list.1 To this end, the NHS is adopting standardised processes and optimised surgical procedures. For example, the implementation of surgical hubs is expected to conduct planned, elective procedures only to improve patient outcomes and reduce pressure on hospitals.1 These hubs focus on specific types of low-complexity surgeries, such as cataract surgery and hip replacement (ophthalmology and orthopaedic patients comprise approximately 22% of the waiting list for surgery).1 This not only improves patient outcomes but also frees up valuable resources for other critical services.

The NHS aims to significantly increase diagnostic capacity by investing in more than 160 community diagnostic centres (CDCs). This planned expansion of CDCs is expected to increase testing capacity to approximately 9 million more tests and checks by 2025. Delivering bundles of tests in a single appointment would increase efficiency, allow for a better experience for patients and ease the pressure of diagnostic capacity at acute hospital sites.1

Creating Capacity by Reducing length of stay (LoS)
There are a number of ways that the NHS can reduce the LoS by standardising processes and optimising procedures:

  • Early Discharge Planning: Implementing proactive discharge planning from the day of admission can significantly reduce LoS.3
  • Process Mapping: Identifying bottlenecks and causes of delay in care, especially around discharge, ensures smoother patient flow.3
  • Predictive Discharge Methods: Reducing variation and eliminating delays through predictive models improves efficiency.4
  • Smoothing Demand: Distributing surgical demand across the week, including shared resources like critical care, minimises peaks and troughs.3

Delayed discharges in hospitals come with a hefty price tag. On average, each patient’s extended stay costs approximately £200–565 per day.5 The cumulative impact is staggering: the NHS in England spends £820 million annually on patients who experience discharge delays.5 These delays tie up valuable resources, as patients continue to occupy beds at a level of care they no longer require.5 Addressing this issue is crucial for both financial efficiency and patient well-being.

Mr Merzesh Magra, Consultant Surgeon, Lead for Morecambe Short Stay programme stated that “Patients just love going back to their own home, rehabilitating in their own environment. [There’s not the disruption of the ward environment] buzzers and beepers, blood pressure cuffs inflating on their arms, intermitted calf compression on their legs, and being disturbed every 10 minutes. Patients tend to rehabilitate well in their own environment, as long as they feel supported remotely, and they just tend to do a lot better.”

The upcoming months could see heightened stress on hospitals due to winter-related flu outbreaks and staff shortages. A recent report showed daily flu hospitalisations nearing 3,746 in the week before 25 December 2022, emphasising the seasonal surge.6 This highlights the need for optimising NHS procedures to manage the anticipated strain on hospitals.

Strategies for Improvement
The surgical backlog in the NHS is expected to grow until March 2024, with estimates suggesting that the waiting list could reach as many as 10.7 million people.2 The NHS stands at a critical juncture, grappling with escalating surgical backlogs, resource constraints, and seasonal pressures. While the situation is undeniably challenging, there is room for targeted interventions and process optimisation within existing resources. Strategies like the development of surgical hubs, expansion of community diagnostic centres, and improving the efficiency of patient stays through proactive planning offer promising avenues for alleviating the current strain. Given the impending winter pressures and the chronic issue of delayed discharges, it is imperative that these optimisation measures are implemented promptly. As the NHS navigates these complexities, the focus must remain on safeguarding both patient outcomes and the long-term sustainability of this vital national institution.

How Johnson & Johnson MedTech can support the NHS
Solutions do exist, but they need a collaborative effort from all stakeholders, from healthcare professionals to administrators, and from patients to policymakers. Johnson & Johnson MedTech’s Services & Solutions (J&J MedTech S&S) offers a suite of specialised services designed to address these backlog challenges, such as:

  • Pathway Audits
  • Gap Analysis
  • Healthcare Transformation Experts
  • Interventions and Change Management

Implementation of J&J MedTech Theatre Efficiency programme at the Wrightington, Wigan and Leigh NHS Trust improved efficiency by reducing variation in start and finish time and increased surgical utilisation by 9%. Average Surgical Utilisation (SU) increased by 4%. This equated to a 9% increase in utilisation, which translates to an additional 19.6 minutes of time that a surgeon is operating (assuming an 8-hour day). As the finish time has improved by 23.3 minutes, this suggests that these 19.6 minutes are occurring within the surgeon’s working day. Given the £1,200/hour average cost of running an operating theatre, every minute used more efficiently not only increases theatre capacity but is worth £20, suggesting that improved SU brings both cost and efficiency benefits.7 As the world’s largest Healthcare company we understand Healthcare and the reality of the situation. Our focus would be to support in improving start times, turnaround times and reducing unnecessary use of agency staff which in turn should lead to significant cost improvements and fewer cancellations.

“The J&J team have put a mirror up to us and shown us the areas we need to improve. The difference then is that they have provided the energy and enthusiasm to impact the change. You guys aren’t like the other consultancies in that you know the system, so you don’t patronise us by telling us things that we already know.”
Mark O’Halloran, Lead Nurse Barts Health Orthopaedic Centre

By integrating these services into the NHS's broader strategy for tackling surgical backlogs, J&J MedTech’s S&S contributes to a multi-pronged approach that aims to enhance operational efficiency while improving patient outcomes. This collaborative model not only addresses immediate concerns but also builds a foundation for long-term sustainability and excellence in healthcare delivery.

Learn more about how J&J MedTech Services & Solutions can help you streamline processes and implement best practices to maximise bed capacity and improve patient flow



  1. NHS. Delivering plan for tackling the COVID-19 backlog of elective care. 2022.
  2. The Health Foundation: The NHS waiting list: when will it peak? Available at: https://www.health.org.uk/waiting-list [Accessed November 2023].
  3. NHS England. Reducing Length of Stay (LoS) for Improved Outcomes. Available at: https://www.england.nhs.uk/wp-content/uploads/2021/12/qsir-reducing-length-of-stay.pdf [Accessed November 2023].
  4. Yacoub Abuzied, et al. Reducing the Length of Stay by Enhancing the Patient Discharge Process: Using Quality Improvement Tools to Optimize Hospital Efficiency. Global Journal on Quality and Safety in Healthcare. 2021;4(1):44–49.
  5. Cadel L, et al. Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ Open 2021;11:e044291.
  6. The Guardian. Flu continues to spread in England with number of hospital patients up 79%. Available at: https://www.theguardian.com/society/2022/dec/30/flu-england-number-of-hospital-patients-up-covid [Accessed November 2023].
  7. Johnson & Johnson Medical Limited UK team. Minimising variation, maximising theatre efficiency. Theatre efficiency programme, case study: Wrightington Wigan & Leigh NHS Trust, UK.