NHS warned its ‘Monday to Friday culture’ is costing lives and wasting billions

The NHS must end its Monday to Friday culture to save lives and billions of pounds, emergency doctors are to tell Health Secretary James Murray.

The Royal College of Emergency Medicine (RCEM) says bank holiday and weekend slowdowns are associated with thousands of extra deaths and billions of pounds of waste.

The college is preparing to raise the issue with the new Health Secretary Mr Murray and Department of Health and Social Care officials as ministers draw up plans for the future of the health service.

The RCEM says hospitals are trying to cope with seven-day demand using systems that still largely operate on a Monday-to-Friday model.

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Its president, Dr Ian Higginson, a consultant in emergency medicine and President of the Royal College of Emergency Medicine, said the mismatch is creating dangerous bottlenecks throughout the NHS.

It comes as emergency care delays are being linked to a mounting death toll.

RCEM estimates that 15,860 excess deaths were associated with long A&E waits in England last year - equivalent to around 305 deaths every week.

And numerous studies have shown an 11 percent increase in deaths at weekends - regardless of whether a patient is in the emergency department or awaiting planned surgery.

New figures show the scale of the problem. New figures show the NHS waiting list crept up to 7.22 million in April, after falling slightly over recent months, and remains almost three million higher than before the Covid pandemic.

Cancer waiting times have also worsened, with performance falling to its lowest level for eight months.

Figures also released last week show 2,241 patients per day are treated in A&E corridors and a further 669 per day are looked after in cupboards, offices, car parks and lavatories - almost 3,000 patients daily.

At the same time, nearly 1.74 million patients waited at least 12 hours in A&E last year, while almost half a million waited more than 24 hours.

Dr Higginson said: “This is not about lazy doctors.

“The fundamental problem is that emergency care happens without respect to traditional working hours. Patients come in round the clock. Our systems are built around the traditional working week.

“The nurses are there, the porters are there, the catering staff are there and the cleaners are there. But most services operate on a five-day week with on-call provision at other times.”
He said hospitals effectively switch from a full service during weekday office hours to a reduced service outside those times.

“Hospitals go full tilt from 9 to 5 but they drop to an on-call level at evenings and weekends and long bank holidays,” he added.

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“The whole system does not flow and it’s not funded to do this and it is not staffed properly fully seven days a week.”

One NHS advisor, who preferred not to be named, agreed. He said: “No hospital in the UK will ever flow, unload the wards efficiently or clear the emergency corridor care until we have a full seven day service.”

The RCEM argues that one of the biggest causes of overcrowding is the difficulty in discharging patients once they have been admitted to hospital.

Many patients can receive emergency scans and treatment when they arrive, but then face delays accessing tests, therapists, social care assessments and community services needed to get them safely home.

“Most hospital emergency patients can get a CT scan, an X-ray and often an MRI and get admitted to a ward, but experience longer hospital stays if these are not available once they are on the ward and they’re not an emergency,” Dr Higginson said.

He said services such as GP practices, physiotherapy, occupational therapy, social care support, community nursing and mental health teams often operate at reduced levels outside the traditional working week.

As a result, patients come to hospital when they don’t need to and hospitals fill up with patients who are medically fit to leave but have nowhere to go when support services are shut.

“The busiest can be weekends and over long bank holidays because people are out and about and all services are not available,” he said.

“People go where the lights are on.”

The consequence is severe overcrowding at the start of every week.

“These become the worst days of overcrowding following the weekends - Mondays and Tuesdays - because we are dealing with the backlogs rather than with what is happening and the patients coming in. It is even worse after long bank holidays.

Long waits are not only dangerous but expensive.

Research has shown patients admitted after lengthy waits in emergency departments often stay in hospital significantly longer than those admitted promptly.

Dr Higginson said this creates a vicious circle, with fewer beds available for incoming patients, worsening delays throughout the system.

“One recent study showed that when patients are admitted from the emergency department following a long wait they stay a lot longer,” he said.

“This is costing the Health Service and the taxpayer £1.2 billion a year and is linked to 2 million extra bed days. This is wasted money doing things badly and inefficiently and we will be calling for this to change.”

He added: “If the NHS worked as a fully seven day operation we could get people assessed and treated from home or in other healthcare settings.“This is about doing today’s work today and not building up queues for later.”

The RCEM wants a fully seven-day service built into the Government’s long-term NHS reforms, with more hospital doctors to cover the extra days, greater access to diagnostics, therapists, discharge teams and community services throughout the week.

“We need a mission to do this,” Dr Higginson said.

A Department of Health and Social Care spokesperson said: “It is unacceptable for patients to face long waits for emergency care, and hospitals should ensure that key services are available every day of the week, not just Monday to Friday, so that healthy patients can be discharged safely and promptly while creating space for others that need it.

“To reduce pressure on A&E, this government is investing more than £215 million in 40 new and expanded same-day emergency care and urgent treatment centres across England, and while deploying specialist teams to trusts with the highest levels of corridor care.

“Despite record demand, the NHS delivered a stronger performance this winter but, with record investment, we are going even further to modernise urgent and emergency care and make sure every patient gets the treatment they need, when they need it.”

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