The COVID-19 pandemic has profoundly disrupted global elective surgical care . There are presently 5 million people in the UK on an elective surgical waiting list, a number expected to grow in the coming months . The capacity of peri-operative services is finite. Increasing this to address the backlog is a substantial challenge and expected to be the rate-limiting step . Restoration of elective surgical pathways will be complicated by the need to mitigate the risk of peri-operative COVID-19 infection and its significant implications for patients and staff . This situation has effectively created a generation of patients waiting longer for treatment, with reduced pre-operative support driving increased levels of patient anxiety and reduced ‘preparedness’ for surgery. Given the major continued burden on front-line NHS staff , a co-ordinated national response comprising innovative solutions is required to address this problem.