The Royal College of Emergency Medicine (RCEM) has issued a stark warning that the NHS's five-day working model is costing lives and wasting billions of pounds. The college is set to urge Health Secretary James Murray to end the Monday-to-Friday culture, which it says is linked to thousands of extra deaths and significant financial losses.
Weekend and bank holiday slowdowns linked to deaths
According to the RCEM, bank holiday and weekend slowdowns are associated with thousands of excess deaths and billions of pounds of waste. The college is preparing to raise the issue with Mr. Murray and Department of Health and Social Care officials as ministers develop long-term plans for the health service.
Dr. Ian Higginson, President of the RCEM and a consultant in emergency medicine, stated that hospitals are struggling to meet seven-day demand with systems that largely operate on a Monday-to-Friday basis. This mismatch creates dangerous bottlenecks throughout the NHS.
Mounting death toll and waiting times
Emergency care delays are being linked to a rising death toll. The RCEM estimates that 15,860 excess deaths were associated with long A&E waits in England last year, equivalent to around 305 deaths per week. Studies have also shown an 11% increase in deaths at weekends, regardless of whether patients are in the emergency department or awaiting planned surgery.
New figures reveal the scale of the problem: the NHS waiting list reached 7.22 million in April, almost three million higher than before the COVID-19 pandemic. Cancer waiting times have also worsened, falling to their lowest level in eight months. Additionally, 2,241 patients per day are treated in A&E corridors, and 669 per day are cared for in cupboards, offices, car parks, and lavatories—totaling nearly 3,000 patients daily. Last year, almost 1.74 million patients waited at least 12 hours in A&E, with nearly half a million waiting more than 24 hours.
Call for a fully seven-day service
Dr. Higginson emphasized that the issue is not about lazy doctors but about a system built around the traditional working week. “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,” he said.
He explained that hospitals effectively switch from a full service during weekday office hours to a reduced service at other 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. “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.”
An anonymous NHS advisor agreed, stating: “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.”
Discharge delays and overcrowding
The RCEM argues that one of the biggest causes of overcrowding is the difficulty in discharging patients after admission. Many patients receive emergency scans and treatment upon arrival but face delays accessing tests, therapists, social care assessments, and community services needed for safe discharge. Dr. Higginson noted that 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 unnecessarily, and hospitals fill up with patients who are medically fit to leave but have nowhere to go when support services are closed. “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.”
This leads to severe overcrowding at the start of every week, with Mondays and Tuesdays being the worst days due to backlogs. Long waits are not only dangerous but also expensive. Research shows that patients admitted after lengthy waits in emergency departments often stay in hospital significantly longer than those admitted promptly.
Financial impact and proposed reforms
Dr. Higginson highlighted the financial burden: “One recent study showed that when patients are admitted from the emergency department following a long wait they stay a lot longer. 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 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.
Government response
A government spokesperson responded: “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.”
The spokesperson added that the government is investing more than £215 million in 40 new and expanded same-day emergency care and urgent treatment centres across England, and 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.”
